Virginia Virginia Motion Picture Production Tax Credit

Virginia Motion Picture Production Tax Credit
Draft Form MPC - Virginia Motion Picture Production Tax Credit Refund Request
VIRGINIA
Form MPC

Tax Year
Refund Request
Virginia Motion Picture Production Tax Credit ___________

By submitting this form, a pass-through entity (PTE) may request a direct refund of the Virginia Motion Picture Production Tax Credit
instead of allocating the credit to individual partners, shareholders, or members. Any credit amount refunded directly to the PTE may not
be allocated to the entity owners on the Virginia Schedule VK-1 or claimed on the Virginia income tax return of any entity owner.
Before a refund can be issued, the PTE must file the Virginia Form 502, Pass-Through Entity Return of Income and Return of Nonresident
Withholding Tax, for the current period and be registered with the Department. Visit www.tax.virginia.gov to register online or download
and complete the registration application, Form R-1, if the PTE has not registered or filed tax returns previously with the Department.
Form 502 and the Form 502 instructions are also available on the Department’s website.
You must enclose a copy of the credit certificate issued by the Virginia Film Office.

Section I: Credit Holder Information
Legal Entity Name

FEIN

Trade Name

Office Use Only

Street Address

City, State, ZIP Code

Contact Email

Contact Name

Contact Phone Number

Entity Type: (Check One)	

  Partnership	

 LLC	

Contact Fax Number

  Other _________________________

Amount of Refund Requested: $______________________

Section II: Authorized Representative Information
Name

Title

Business Name

Affiliation

Street Address

City, State, ZIP Code

Phone Number

Fax Number

Email

Section III: Declaration
I, the undersigned owner or representative authorized to act on behalf of the PTE identified in Section I above, declare, under the
penalties provided by law, that this form (including any accompanying schedules, statements, and attachments) has been examined by
me and is, to the best of my knowledge and belief, a true, correct, and complete application, made in good faith pursuant to the income
tax laws of the Commonwealth of Virginia. I certify that all owners of the PTE agree to this request for the tax credit refund to be issued
directly to the PTE. Additionally, I certify that any credit amount that is refunded directly to the PTE will not be allocated to the entity
owners on Virginia Schedule VK-1 or claimed on any Virginia income tax return by any entity owner.
Signature of Owner or Authorized Representative

Title

Printed Name

Phone Number

Mail to:	 Virginia Department of Taxation
	
Tax Credit Unit
	
P.O. Box 715
	
Richmond, VA 23218-0715
Va. Dept. of Taxation  2604045  Rev. 08/17

Fax to: (804) 774-3902
For assistance, call: (804) 786-2992

Date