Form Et-1 - Financial Institution Excise Tax Return - 2006 Page 2
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Form ET-1 (2006)
SCHEDULE A – Dividend Income
Payor Corporation:
Domestic Corps.
Foreign Corps.
TOTAL TO LINE 2, PAGE 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
SCHEDULE B – Gain or (Loss) On Sale of Assets
Depreciation
Description
Sales Price
Cost
Net Gain (Loss)
or Amortization
TOTAL TO LINE 4, PAGE 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
SCHEDULE C – Compensation of Officers
Stock Ownership
Name of Officer
Title
Amount of Compensation
Common
Preferred
TOTAL TO LINE 7, PAGE 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
SCHEDULE D – Bad Debts – Reserve Method (See Instructions)
Amount Added To Reserve
Trade Notes And Accounts
Sales On
Amount
Reserve For
Year
Receivable Outstanding
Account
Current Year’s
Recoveries
Charged Against
Bad Debts At
At End of Year
Provision
Reserve
End of Year
2000
2001
2002
2003
2004
2005
SCHEDULE E – Taxes Deducted
SCHEDULE F – Taxes Used As Credits
Franchise Taxes and Permits
Sales Taxes: Supplies, etc.
Privilege Taxes
Furniture, Fixtures
Social Security Taxes
Use Taxes
Ad Valorem Taxes
State Tax on Utilities
Other Taxes – Attach Schedule
State Tax on Telephone
TOTAL TO LINE 12, PAGE 1 . . . . . . . . . . . . . .
Other Allowable Credits
TOTAL TO LINE 33, PAGE 1 ………………
SCHEDULE G – Depreciation
Date
Cost or
Prior
Current
Type of Property
Method
Life
Acquired
Other Basis
Depreciation
Depreciation
TOTAL TO LINE 15, PAGE 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
AFFIDAVIT
I authorize a representative of the Department of Revenue to discuss my return and attachments with my preparer.
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements and to the best of my knowledge and belief, they
Please
are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Sign
Here
Your signature
Date
Title or Position
Date
Preparer’s Social Security No.
Preparer’s
Paid
signature
Preparer’s
Firm’s name (or yours
E.I. No.
Use Only
if self-employed)
ZIP Code
and address
Telephone
Person to contact for information
(
)
concerning this return . . . . . . . . . . . . . . . . . . . . . . . . . Name
Number
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Parent category: Financial