Indiana Application for Foster Care Donation Credit

Application for Foster Care Donation Credit
Form FDC-A
Form FCD-A

State Form 53019 (R2 / 6-23)

Indiana Department of Revenue

Application for Foster Care Donation Credit

Indiana Department of Revenue
P.O. Box 6104
Indianapolis, IN 46206-6104

INSTRUCTIONS:
1.	 This form is to be completed by an individual or entity applying for approval of the Foster Care Donation Credit.
2.	 Include proof of your monetary donation to the Insuring Foster Youth Fund or a qualifying foster care organization with your application.
3.	 Mail the completed form to the above address or fax to 317-233-5439.
4.	 Indiana Department of Revenue (DOR) will send an approval or denial letter within 45 days. If approved, DOR will issue a
certification number to be used when filing your income tax return.
Important Notice
A person who makes a monetary donation to the Insuring Foster Youth Fund or to a qualifying foster care organization may apply
to DOR to receive a tax credit equal to 50% of the amount of the monetary donation up to a maximum of $10,000. Credit must be
claimed in the same taxable year in which the monetary donation is made. Any unused credit is nonrefundable. Total funding for this
credit is limited to $2,000,000 on a calendar year basis. Visit www.in.gov/dor/tax-forms/foster-care-credit-donation-information for a
current list of qualifying foster care organizations and remaining amount of credits available.
Section 1: Applicant Information
Name of Applicant

Social Security Number (last 4 digits) or FEIN (all 9 digits)

Mailing Address (number and street or PO box)
Telephone Number

City, State, and ZIP code
Email Address

Section 2: Donation Information
List the amount(s) donated and either the name of a qualifying organization or the Insuring Foster Youth Fund.
If you made donations to more than two (2) qualifying organizations, complete and attach an additional Form FCD-A.
Enter Amount of Donation

Name of Foster Care Organization

Enter Amount of Donation

Name of Foster Care Organization

Enter Amount of Donation to the Insuring Foster Youth Fund

Complete the following to calculate the Foster Care Donation Credit:
1.	 Enter total amount of the donation(s)........................................................................................................... __________________
2.	 Multiply the amount on line 1 by 50% (0.5).................................................................................................. __________________
3.	 Enter the lesser of $10,000 or the amount reported on line 2...................................................................... __________________
Signature of Applicant or Authorized Designee
Printed Name

Date (month, day, year)
Title (if applicable)

FOR DOR USE ONLY

	The request is approved.
	The request is partially approved because one or more of the foster care organizations is a non-qualified organization.
	The request is denied because proof of donation was not included.
	The request is denied because all organizations are non-qualifying.
	The request is denied because the department has exceeded the allotted amount of credit that may be granted/approved.
Signature of DOR Analyst

Postmark Date (month, day, year)

Date of Review (month, day, year)