Form R-10613 Fillable New Markets Tax Credit Transfer Form
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

(Equity interest or Account ID Number: Account ID Number: Allowance Date: Amount previously Applicable Credit balance from ACAD: $ Baton Rouge LA 70896 6362 claimed by Transferor Credit Transfer Form current credits): Date of Notification Date of Sale/Transfer: Balance after transfer: $ each credit allowance date from ACAD: If a sale of credits or a transfer of credits covers more than one Initial Credit Allowance Date separate forms must be submitted indicating IMPORTANT January 1 2009 For credits issued after January 1 2009 a Tracking Number was assigned when the credit was issued Either the Louisiana Department of Revenue Nature of sale New Markets Tax Office Audit Division Original Investor Louisiana Revenue P O Box 66362 PLR number OR the Tracking Number MUST be provided when submitting this form The Initial Credit Allowance Date must also be provided Purchase Price: $ Amount being R 10613 (10/09) Return to: sold by Transferor The PLR number is the Private Letter Ruling Number that was issued to the original investor when the credit was issued prior to This form must be submitted to the Department of Revenue within thirty days of the sale or transfer Tracking Number Initial Credit Allowance Date Transferee Louisiana Revenue Transferor Louisiana Revenue Transferor original transferred: $