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Texas Franchise Tax EZ Computation Report
05-169
05-169
(Rev.9-15/7)
(Rev.9-15/7)
Annualized total revenue must be $20,000,000 or less to le this form
Tcode
13252
13252 Annual
Annual
FILING REQUIREMENTS
Taxpayer number
Report year
Due date
2 0 1 6
05/16/2016
Taxpayer name
Secretary of State le number
or Comptroller le number
Mailing address
City
State
Country
ZIP code plus 4
Blacken circle if the
address has changed
Blacken circle if Total Revenue is adjusted for
Blacken circle if this is a combined report
Tiered Partnership Election, see instructions
Is this entity a corporation, limited liability company, professional association, limited partnership or nancial institution?
Yes
No
NAICS code
m
m
d
d
y
y
m
m
d
d
y
y
Accounting year
Accounting year
**
begin date
end date
REVENUE
(Whole dollars only, items 1 -12)
0 0
1. Gross receipts or sales
1.
0 0
2. Dividends
2.
0 0
3. Interest
3.
0 0
4. Rents
4.
(can be negative amount)
0 0
5. Royalties
5.
0 0
6. Gains/losses
6.
(can be negative amount)
0 0
7. Other income
7.
(can be negative amount)
0 0
8. Total gross revenue
8.
(Add items 1 thru 7)
0 0
9. Exclusions from gross revenue
9.
(see instructions)
0 0
10. TOTAL REVENUE
10.
(item 8 minus item 9 if less than zero, enter 0)
0 0
11. Gross receipts in Texas
11.
0 0
12. Gross receipts everywhere
12.
13. Apportionment factor
13.
(Divide item 11 by item 12) (Round to 4 decimal places)
14. Apportioned revenue
14.
(Multiply item 10 by item 13) (Dollars and cents)
15. Tax due before discount
15.
(Multiply item 14 by 0.00331) (Dollars and cents)
16. Discount
16.
(see instructions, applicable to report years 2008 and 2009)
17. TOTAL TAX DUE
17.
(item 15 minus item 16) (Do not include payment if this amount is less than $1,000)
Do not include payment if item 17 is less than $1,000 or if annualized total revenue is less than the no tax due threshold (see instructions).
If the entity makes a tiered partnership election, ANY amount in item 17 is due. Complete Form 05-170 if making a payment.
Print or type name
Area code and phone number
(
)
-
Mail original to:
I declare that the information in this document and any attachments is true and correct to the best of my knowledge and belief.
Texas Comptroller of Public Accounts
Date
P.O. Box 149348
Austin, TX 78714-9348
Instructions for each report year are online at If you have any questions, call 1-800-252-1381.
** If not 12 months, see instructions for annualized revenue.
Texas Comptroller O cial Use Only
VE/DE
PM Date