2009
                                                          Allotment HRC                                                                                                                    Massachusetts
                            Historic RehabilitationDepartment of
                                                                                                                                                                                           Revenue
                                                          Credit Summary

For calendar year 2009 or taxable year beginningand ending
Name of project                                           Building identification number

Street address                                            City/Town                                                 State                                                                  Zip

Name of project owner                                     Federal Identification number

Street address                                            City/Town                                                 State                                                                  Zip

Certificate Number
Certificate number issued by Massachusetts Historical Commission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 
Allotment Information
Total amount allotted to other taxpayers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Distribution Information
                                                          Social Security number or 
               Name of recipient                          Federal Identification numberAmount of credit being allotted

Distribution to Partners, Members or Owners
If the project distributes or assigns any portion of the credit to its partners, members or owners, the project or owner must complete an Allotment HRC His-
toric Rehabilitation Credit Summary. In addition, the project or owner must fill out and provide to each partner, member or owner, an Individual Certificate
HRC, Historic Rehabilitation Credit, indicating the amount of the individual credit distributed or assigned.
Tax Return Filing
The project or owner must file a copy of the Project Certificate issued by the Massachusetts Historical Commission, and copies of both the Allotment HRC
Historic Rehabilitation Credit Summary and the Individual Certificate HRC, with its Massachusetts tax return. In addition, partners, members or owners re-
ceiving an Individual Certificate HRC, must file copies of the certificate and copies of the attendant Project Certificate and Allotment HRC Historic Rehabili-
tation Credit Summary with their Massachusetts tax return.
Department of Revenue Filing
The project or owner must file a copy of the Project Certificate issued by the Massachusetts Historical Commission, and copies of both the Allotment HRC
Historic Rehabilitation Credit Summary and the Individual Certificate HRC, with the Department of Revenue. Mail to: Massachusetts Department of Rev-
enue, Audit Division, 200 Arlington Street, Room 4300, Chelsea, MA 02150, Attn.: Historic Rehabilitation Unit.