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Dr116200 Fillable (Florida)

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Florida Tax Credit Scholarship Program
Notice of Intent to Transfer a Tax Credit
DR-116200
R. 01/19
Rule 12-29.003, F.A.C.
Effective 01/19
Page 1 of 2
To transfer a tax credit available under the Florida Tax Credit Scholarship Program, the transferring business and the receiving business must
both be members of the same affiliated group of corporations.
Part I - Transferring Business Information
Business Name:
Business Address:
City:
Federal Employer Identification Number (FEIN):
Contact Person Name:
Telephone Number:
Email Address:
State:
ZIP
If the transferor is included in a consolidated Florida corporate income tax return, please provide the Parent Corporation Name:
Parent FEIN:
Indicate the type of tax credit allocation or tax
credit to be transferred, information on the
original amount of the tax credit allocation,
any approved carryforward amounts, the
amount of any previous transfers, and the
amount to be transferred. For transfers of
sales and use tax or the excise tax on liquor
beverages, wine beverages, or malt
beverages, indicate the certificate number or
license number for which the tax credit
allocation was authorized.
Florida Tax Credit Scholarship Program:
Corporate Income Tax
Insurance Premium Tax
Tax on Oil Production
Tax on Gas Production
Sales and Use Tax (enter certificate number):
Excise Tax on Liquor Beverages (enter license number):
Excise Tax on Wine Beverages (enter license number):
Excise Tax on Malt Beverages (enter license number):
Transfer of Tax Credit Allocation
Tax Credit Allocation Confirmation Number
Original Amount of Tax Credit Allocation
Prior Transfer of This Credit Allocation
Requested Transfer of This Credit Allocation (Must be made in sufficient time
for transferee to timely make the contribution to earn the credit and the
Department to approve the transfer of the credit allocation.)
Prior Transfer of This Credit or Carryforward Credit
Tax Year or Month / Year Claimed / Used
Amount of Credit and Carryforward Credit Claimed / Used
Credit Earned Under This Tax Credit Allocation Confirmation Number
Transfer of Credit or Carryforward Credit
Business Name:
Business Address:
City:
Federal Employer Identification Number (FEIN):
Contact Person Name:
Telephone Number:
Email Address:
State:
ZIP
If the transferee is included in a consolidated Florida corporate income tax return, please provide the Parent Corporation Name:
Parent FEIN:
Part II - Receiving Business Information - A separate notice is required for each receiving business.
$
$
$
$
Requested Transfer of This Credit or Carryforward Credit (Must be
made in sufficient time for the transferee to timely claim the transferred
credit or transferred carryover credit and the Department to approve the
transfer of the credit or carryforward credit.)
For transfers of sales and use tax or the
excise tax on liquor beverages, wine
beverages, or malt beverages, indicate the
certificate number or license number of the
business receiving the transfer.
Sales and Use Tax (enter certificate number):
Excise Tax on Liquor Beverages (enter license number):
Excise Tax on Wine Beverages (enter license number):
Excise Tax on Malt Beverages (enter license number):
DR-116200
R. 01/19
Page 2 of 2
Part III - Transferring Business Certification - Only an authorized officer of the transferring business may sign this notice.
I understand that section (s.) 1002.395(5)(f), Florida Statutes (F.S.), requires the Florida Department of Revenue to provide a copy of any
approval or denial it issues with respect to this application for transfer to the nonprofit scholarship-funding organization indicated on the
associated application for an allocation of credit.
Under penalties of perjury, I certify that the Transferring Business and the Receiving Business are both members of the same affiliated group
of corporations. I understand that the Florida Department of Revenue will provide information regarding the transfer of a tax credit allocation
or a tax credit authorized under the Florida Tax Credit Scholarship Program to the Receiving Business. I declare that I have read the
foregoing Notice and the facts stated in it are true.
Signature of Authorized Officer of Transferring Business Title
Printed Name of Authorized Officer Date
Instructions for Florida Tax Credit Scholarship Program
Notice of Intent to Transfer a Tax Credit
To transfer a tax credit or a tax credit allocation under the Florida
Tax Credit Scholarship Program both parties to the transfer must be
members of the same affiliated group of corporations.
The transferring member must notify the Department of any tax
credit transfer prior to the receiving member reporting the tax credit
on a tax return. A separate notice must be submitted for each
member of an affiliated group of corporations receiving a transfer.
The completed notice must be signed by an officer authorized to
sign on behalf of the transferring business. Mail the completed and
signed notice to:
Florida Department of Revenue
Revenue Accounting
PO Box 6609
Tallahassee FL 32314-6609
The Department of Revenue will send written approval regarding the
amount of the tax credit transferred after receipt of a completed
notice. You must have a letter from the Department approving the
credit transfer prior to claiming the tax credit on a tax return.
The following tax allocations or tax credits may be transferred from
one member of an affiliated group to another member of the same
affiliated group:
• Tax credit allocations prior to making a contribution to an
eligible nonprofit scholarship-funding organization.
• Tax credit allocations for which contributions have been
made to an eligible nonprofit scholarship-funding
organization, but the tax credit has not been claimed on
a tax return.
• Carryforward tax credit amounts that have not been
claimed on a tax return.
A transferred tax credit may only be used against the same tax as
the original tax credit approved by the Department. For example,
if the transferring member received a sales and use tax credit
allocation, the receiving member may only use the transferred tax
credit as a sales and use tax credit.
Members receiving a tax credit allocation must make a
contribution to an eligible nonprofit scholarship-funding
organization during the same period that the transferring member
was required to make the contribution. The contribution must be
made before the member may claim the tax credit.
A transferred tax credit may only be taken by the receiving
member of the affiliated group during the same period that the
transferring member was approved to take the tax credit.
A transferred carryforward amount may only be taken as a tax
credit during the same time period as the transferring member
was authorized to take the carryforward tax credit amount.
References: Section 1002.395(5)(d), Florida Statutes; Rule Chapter 12-29, Florida Administrative Code
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Dr116200 Fillable (Florida)

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Completed 22 July 2020

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