Free Application for Historic Rehabilitation Tax Credit Certification.xls - Indiana


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APPLICATION FOR HISTORIC REHABILITATION TAX CREDIT CERTIFICATION
State Form 51300 (3-03) Instructions: 1. Read all instructions before completing application 2. Please type or print clearly in black ink. 3. Certification cannot be made unless a completed application form has been received 4. If additional space is required, please attach additional sheets

Division of Historic Preservation and Archaeology 402 W. Washington St., W274, Indianapolis, IN 46204-2739 317-232-1646; FAX 317-232-0693; [email protected]

FOR OFFICE USE ONLY

Project No.
PROGRAM REQUEST State program only. State & Federal programs. PROPERTY INFORMATION

NOTE: A copy of this form will be provided to the Indiana Department of Revenue. BOX #1 This application seeks certification for rehabilitation tax credits under the (check one): BOX #2
Property Name

Property Address (Number and Street)

City

County

Zip Code

BOX #3 Property is listed individually on the Indiana Register of Historic Sites and Structures. Historical name of property: Property is located within a historic district listed in the Indiana Register of Historic Sites and Structures. Name of Historic District: BOX #4 Date Building Constructed:______________________________ Check here to indicate that documentation is attached showing that the structure is at least 50 years old. Use(s) before rehabilitation:___________________________ Proposed use(s) after rehabilitation:______________________ Estimated cost of qualified rehabilitation expenditures (Must be at least $10,000) _____________________________ Check here if this project is to be completed in phases. This application covers phase _____ of _____ phases. Project/phase start date (est.):____________________ Completion date (est.):______________________ BOX #5
Name Daytime Telephone Number

PROPERTY SIGNIFICANCE Date Listed:

BUILDING AND PROJECT DATA Type of Construction: Number of square feet on ground floor before rehabilitation:____________ Check here to indicate that drawings of current ground floor plan, including dimensions, is attached. Number of square feet on ground floor after rehabilitation:____________ Check here to indicate that drawings of proposed ground floor plan, including dimensions, is attached. Total area before rehabilitation:__________ Total area after rehabilitation:__________ PROJECT CONTACT

Address (Number and Street)

City

County

State

Zip Code

E-mail Address (optional)

BOX #6
I affirm under the penalty for perjury that the information I have provided is, to the best of my knowledge, correct and that I own the property described above.

PROPERTY OWNER
Organization/Company

Name of Signator

Address (Number and Street)

Daytime Telephone Number

City

County

State

Zip Code

E-mail Address (optional)

Social Security Number or Tax ID #

Owner Signature

Date

State Form 51300 (3-03)

HISTORIC REHABILITATION TAX CREDIT APPLICATION INSTRUCTIONS
The State Historic Rehabilitation Tax Credit Certification Application is to be completed in addition to the Federal Historic Preservation Certification Application when applying for a State tax credit. The State application basically follows the format of the Federal program. The differences are noted on the accompanying "Indiana Historic Rehabilitation Tax Credit Program" fact sheet. The Federal form should be completed even when the taxpayer is applying only for a State tax credit. When applying for the State tax credit program alone, submit only the original application. When applying for the Federal and State programs, two (2) copies of the Federal application are required, one for the Division of Historic Preservation and one that will be forwarded to the National Park Service. BOX #1 - Program Request: This application seeks certification for rehabilitation tax credits under the State program or Federal and State programs. Check the appropriate box. NOTE: There are some differences in the two programs, so project may qualify for only one program or both. The Federal application form will be completed for all rehabilitation tax credit projects. BOX #2 - Property Information: Provide the name of the property. This is generally its street address. If the building is known by a historic name, include this name also. These names should be consistent in each part of the application. BOX #3 - Property Significance: The applicant should check the appropriate box indicating whether the building is listed individually on the Indiana Register of Historic Sites and Structures, or as contributing to a historic district that is presently listed on the Indiana Register of Historic Sites and Structures. NOTE: All properties in Indiana that are listed on the National Register of Historic Places are listed on the Indiana Register. However, not all properties on the Indiana Register are on the National Register. Please note the register(s) on which the property is listed if applying for both programs. State law requires a rehabilitation property to be listed on the Indiana Register in order to qualify for a State tax credit. If a property is not listed when the application is initially submitted to the Division, the Division will indicate on the certification form whether the property is eligible for the Indiana Register. The property must be listed on the Register in order to receive final certification of the completed work. BOX #4 - Building and Project Data: Date building constructed - Check the box indicating that documentation establishing that the building is at least 50 years old is attached. This documentation can consist of the following: (a) historic property surveys or inventories that indicate the age of the historic structure, (b) articles from newspapers or periodicals which are dated to confirm the building's age, (c) construction records, (d) original architectural drawings, (e) other documents or records approved by the Division. Use(s) before rehabilitation - Indicate previous use(s) of the building and the proposed use after rehabilitation. Estimated cost of qualified rehabilitation expenditures - Provide the estimated cost of the rehabilitation work. NOTE: State law requires that at least $10,000 in qualified expenditures be spent on the rehabilitation. The Federal program requires qualified expenditures to be the greater of $5,000 or the adjusted basis of the property. Check here if this project is to be completed in phases - Check box if appropriate and give the number of the phase being described and the total number of phases. NOTE: For both the Federal and State programs, a complete description and time schedule for all phases must be provided in the application. Any changes or additional information may be submitted later as amendments. Construction (including demolition) for the rehabilitation project may take up to two years to complete, except in the case of a phased project, in which work may take up to five years. BOX #5 - Project Contact: Provide the name, mailing address, telephone number and e-mail address (optional) for the principal individual responsible for filing the application and/or managing the work. BOX #6 - Property Owner: Provide the name, mailing address, telephone number(s), e-mail address (optional), and the Social Security Number or Tax ID # for the owner of the property. This information may be at variance to the building location identified in Box #2 and contact information provided in Box #5. THE OWNER MUST SIGN THIS SECTION OF THE APPLICATION SIGNIFYING THAT THE INFORMATION PROVIDED IS COMPLETE AND CORRECT.

State Form 51300 (3-03)

HISTORIC REHABILITATION TAX CREDIT PROGRAM FACT SHEET

Historic rehabilitation tax credit program is available to Indiana State Income taxpayers who undertake certified rehabilitations of historic structures. Modeled on the Federal historic preservation tax credit incentive, the new State credit program differs from the Federal program in some ways. The State incentive allows a taxpayer to take a State income tax credit for 20% of the total qualified rehabilitation or preservation cost of a project, up to a maximum of $100,000 in tax credit per project. The program is administered by the Division of Historic Preservation and Archaeology, Indiana Department of Natural Resources. The following conditions must be met to qualify for an Indiana historic rehabilitation tax credit. When applying for both Federal and State tax credits, please note the differences in requirements for the two programs.

Additional provisions of the program: * Any unused portion of an allowed credit that results from limited annual tax liability may be carried forward and applied to succeeding taxable years for up to 15 taxable years following the initial credit year. * The tax credit can be recaptured from the taxpayer if the property is transferred within five (5) years after completion of the certified rehabilitation or preservation work, or if additional modifications to the property that do not meet the "Standards for Rehabilitation" or the "Standards for Historic Preservation Projects" are undertaken less than five (5) years after completion of the certified rehabilitation. * The total amount of historic rehabilitation tax credits allowed for each state fiscal year cannot exceed $450,000. Each certified application will be placed in a queue and qualify for a tax credit for the current State fiscal year, provided that all project certified previously have received credits and provided that the $450,000 cap on credits for the current fiscal year has not been exceeded. Certified applications not qualifying for a credit will be placed in a queue for a credit for the next fiscal year. The same pattern will continue thereafter for each subsequent fiscal year. * There is no fee for obtaining a tax credit certification from the Division. * The Indiana Historic Rehabilitation Tax Credit Certification Application consists of the Federal Historic Preservation Certification Application plus an addendum for information required for the State tax credit program.

* The property must be located in Indiana. * The structure must be at least 50 years old. * The property must be listed on the Indiana Register of Historic Sites and Structures. * The property must be income-producing. * Qualified rehabilitation or preservation expenditures must total at least $10,000. * Rehabilitation projects must comply with the "Secretary of the Interior's Standards for Rehabilitation," and preservation projects must comply with the "Secretary of the Interior's Standards for Historic Preservation Projects." * Proposed rehabilitation or preservation work must be approved by the Division of Historic Preservation and Archaeology prior to demolition or constructions. * Rehabilitation work must be completed within two (2) years after beginning the physical work of demolition or construction, or within five (5) years if the approved plan authorized that the rehabilitation is to be completed in phases.

For applications please contact:

and/or

additional

information,

Indiana Department of Natural Resources Division of Historic Preservation and Archaeology 402 West Washington Street, Room W274 Indianapolis, Indiana 46204-2739 (317) 232-1646 [email protected]