• Tax Credit Authorization Form (PRCO)

    Tax Credit Authorization Form (PRCO)

    Parkgate Pregnancy Clinic
  • This application appoints Parkgate Pregnancy Clinic as Business Representative and grants permission to file an application on behalf of the applicant for PRCO. Please return completed form to Parkgate: Carly@Parkgateclinic.com or 150 S Industrial Rd, Tupelo, MS. 38801.

  • APPLICANT INFORMATION (Please type or print clearly)

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  • PREGNANCY RESOURCE CHARITABLE ORGANIZATIONS INFORMATION

    Miss. Code Ann. § 27-7-22.43 provides an income tax, ad valorem tax on real property, insurance premium retaliatory, or insurance premium tax credit for voluntary cash contributions made to qualifying Pregnancy Resource Charitable Organizations (PRCOs) by a business enterprise engaged in commercial, industrial, or professional activities and operating as a corporation, limited liability company, partnership or sole proprietorship. PRCOs must certify that no more than 20% of the contributions received under the Pregnancy Resource Act will be spent on administrative purposes and must file the organization's publicly available IRS filings with the Mississippi Secretary of State. The credit is limited to $10,000,000 for calendar year 2025. No more than $2,500,000 may be allocated for contributions to a single PRCO until June 1st. From and after June 1st, the single PRCO limit of $2,500,000 no longer applies.

    The Department of Revenue will respond within 30 days from the receipt of this application. If a response is not received within 30 calendar days, please contact the Office of Tax Policy using the contact information below. For applications with contributions that have been made, the contribution documentation from Parkgate Pregnancy Clinic verifying the details of the contribution will be submitted with this application to MSDOR at https://tap.dor.ms.gov/_/#10. The documentation may be a letter or receipt and must include (1) the name of the organization, (2) the name of the contributor, (3) the date of the contribution, (4) the amount of the contribution, and (5) a statement of whether any good and/or service was provided in exchange. If any good and/or service was provided in exchange for the contribution, then the documentation must include an itemized statement of the retail or market value of the provided good and/or service. For applications with contributions that have not yet been made or where the contribution documentation that was issued from Parkgate Pregnancy Clinic is not submitted along with the application, the Department will issue a letter earmarking the requested credits along with instructions for the applicant to submit a copy of the documentation from the charitable organization. Applicants have 60 days from the date of this letter or until December 31st of the current year, whichever date is first, to make the contribution. If the contribution is not made or if the Department has not been notified within the 60-day timeframe, the earmarked credits will be made available for allocation to other taxpayers. The Department will issue an approved allocation letter within 30 days upon the receipt of documentation from the charitable organization. The applicant is herein appointing Parkgate Pregnancy Clinic as its business representative for the sole purpose of properly 1) completing the application consistent with the information provided herein; 2) executing (i.e. signing and dating) the application; and 3) submitting the application as required by the MS Department of Revenue.

    I, the undersigned, attest that the cash contributions were made or will be made during the calendar year ending December 31. 2025. As indicated on this completed form, I hereby authorize Parkgate Pregnancy Clinic to apply for an allocation of credits for contributions made to Pregnancy Resource Charitable Organizations. I also hereby attest that the above statements are true and correct to the best of my knowledge and belief.

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  • Schedule of Charitable Contributions to PROCS

  • Instructions: Fill out the table below listing the organization(s) that have received or will receive a cash donation. Note that only contributions to Pregnancy Resource Charitable Organizations (PRCOs) should be submitted on this form. Requests for contributions to Eligible Charitable Organizations (ECOs), EducationalServices Charitable Organizations (ESCOs) or Eligible Transitional Home Organizations (ETHOs), etc., will be disregarded. Lastly, the "Contribution Date" column can be left blank. Applicants are allowed the option to choose one substitute PRCO to replace the "primary" PRCO choice. If the primary PRCO choice has met its annual cap at the time this application has been received, the Department will automatically use the substitute organization. For more information about this credit or to see current listings of PRCOs, go to the following webpage: https://www.dor.ms.gov/charitablecredits.

    Schedule of Contributions to PRCOs

    Name of the Organization to Which Contributions Were Made

    01 PrimaryParkgate Pregnancy Clinic

  • Contribution Amount      .  

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  • Should be Empty: