Form R-10611 Motion Picture Investment Tax Credit Schedule

Filing Period (mm/dd/yyyy) LDR Account ID Louisiana Department of Revenue Motion Picture Investment Tax Credit Schedule* Pursuant to the Provisions of Louisiana Revised Statute 47:6007 * All statutory requirements must have been met and all appropriate documentation must have been provided to the Louisiana Department of Revenue in a timely manner including but not limited to the certification letter issued by the Louisiana Department of Economic Development and letters documenting any subsequent transfer of such credits Failure to provide such documentation in an appropriate and timely manner will result in the disallowance of any credits claimed See RIB 05 001 for additional information PLEASE PRINT OR TYPE R 10611 (11/06) State Certification Number Production Name Transferring Entity LDR Account ID of Transferring Entity Date of Transfer Credits Purchased Credits Sold Credits sold to GOFTD Credits Claimed in Prior Years Credits Claimed on Current Year Return Remaining Credit Balance Taxpayer Name