Application – New Form – Endow Mississippi Tax Credit

Tax Credit Application

Donors who give from a minimum of $1000 to a maximum of $500,000 to an endowment at a qualified community foundation are eligible for a 25% tax credit through the Endow Mississippi Tax Credit Program.

To apply for the credit, please complete and sign the application below.

Applicant Information

Legal Name of Taxpayer(Required)

Federal EIN or SSN(Required)

Taxpayer Email(Required)

Phone(Required)

Fax Number

User Address(Required)

Contact Person

Title

Contact Person Email

Taxpayer or Entity(Required)

Taxpayer(Required)

Entity(Required)

Other(Required)

Gift Information

Community Foundation Names(Required)

Endowment Gift(Required)

Tax Credit Requested(Required)

Tax Credit Estimation

Name of Fund(Required)

Purpose of Fund(Required)

Would you like to contribute to an additional endowment?

Please select an option below:

Add 1 additional endowment

Add 2 additional endowments

Add 3 additional endowments

No, thank you

Endowment Gift(Required)

Tax Credit Requested(Required)

Tax Credit Estimation

Name of Fund(Required)

Purpose of Fund(Required)

Endowment Gift(Required)

Tax Credit Requested(Required)

Tax Credit Estimation

Name of Fund(Required)

Purpose of Fund(Required)

Endowment Gift(Required)

Tax Credit Requested(Required)

Tax Credit Estimation

Name of Fund(Required)

Purpose of Fund(Required)

Total Tax Credit Requested(Required)

Total Tax Credit Estimation

Certification of Taxpayer

Signature of Taxpayer or Authorized Representative(Required)