Virginia TCD-1 - Tax Credit Disclosure Agreement OR Authorization to Disclose Confidential Tax Information Relating to Tax Credits

TCD-1 - Tax Credit Disclosure Agreement OR Authorization to Disclose Confidential Tax Information Relating to Tax Credits
Form TCD-1 - Tax Credit Disclosure Agreement or Authorization to Disclose Confidential Tax Information Relating to Tax Credits
Form TCD-1

Fax to: (804) 774-3902
For Assistance,
Call: (804) 786-2992

Tax Credit Disclosure Agreement
OR Authorization to Disclose Confidential
Tax Information Relating to Tax Credits

Virginia Department of Taxation
Tax Credit Unit
P.O. Box 715
Richmond, VA 23218-0715

SECTION 1 — TAXPAYER INFORMATION – Taxpayer(s) must sign and date this form.
Taxpayer Name(s)

SSN / FEIN

Daytime Phone Number

Hereby authorizes the following representative(s) to act as provided in Section 4:
SECTION 2 — REPRESENTATIVE(S) – Only individuals may be named as representatives.
Name and Address

Phone Number

Fax Number
 Broker	

  CPA		

 Attorney	

  Other _____________________

Name and Address

Phone Number

Fax Number
 Broker	

  CPA		

 Attorney	

  Other _____________________

To represent the taxpayer(s) before the Virginia Department of Taxation for the following tax matters:
SECTION 3 — CREDIT TYPE – Check all that apply and enter the taxable year that each credit originated.
Credit

Taxable
Year

Credit

Taxable
Year

Credit

  Agricultural Best Management

  Livable Home

  Qualified Equity/Subordinated Debt

  Enterprise Zone (nonrefundable)

  Major Business Facility Job

  Recyclable Materials

  Food Donation

  Major Research and Development

  Research and Development

  Historic Rehabilitation

  Motion Picture Production

  Riparian Waterway Buffer

  Land Preservation

  Neighborhood Assistance

  Other ______________________

Taxable
Year

Certificate / Transaction Number(s):

SECTION 4 — INFORMATION AUTHORIZED
The representative(s) are authorized to request, receive, inspect, and discuss the following information for the life of the credit(s) indicated in
Section 3, unless otherwise noted in Section 5.
  Acknowledgment Letter	

  Credit Certificate	

  LPC Balance

SECTION 5 — AUTHORIZATION
This Authorization revokes all previous Authorizations received by the Virginia Department of Taxation for the credits and years or transaction
numbers covered by this form. If there are any exceptions, specify to whom granted, date, and address including ZIP Code on the line below.
Enclose copies of earlier power(s) and authorizations.

SECTION 6 — SIGNATURE OF TAXPAYER(S)
If a tax matter concerns both spouses, each must sign. If signed by a corporate officer, partner, guardian, tax matters partner, executor, receiver,
administrator, or trustee, on behalf of the taxpayer, I certify that I have the authority to execute this form on behalf of the taxpayer.
Signature

Title, if applicable

Date

Signature

Title, if applicable

Date

Va. Dept. of Taxation  8101005  Rev. 08/23