Schedule Qip-C - Qualified Investment Partnership Certification - 2010
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1
2SCHEDULE
100006QP
CY
QIP-C
2010
RESET
SY
FY
A
D
R
LABAMA
EPARTMENT OF
EVENUE
Qualified Investment Partnership Certification
For Calendar Year 2010 or Fiscal Year
Beginning ___________________, 2010 and ending _____________________, ________
1a. LEGAL NAME OF PARTNERSHIP
1b. FEIN
2. Asset Test: According to §40-18-24.2, Code of Alabama 1975, a qualified investment partner-
ship shall have no less than 90% of the cost of its total assets invested in qualifying investment
securities and office facilities and tangible personal property reasonably necessary to carry on its
activity in the State of Alabama as an investment partnership.
2
%
Average Qualifying Asset Percentage for the Taxable Year. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Gross Income Test: According to §40-18-24.2, Code of Alabama 1975, a qualified investment
partnership (QIP) shall have no less than 90% of its gross income from interest, dividends, distri-
butions, and gains and losses from the sale or exchange of qualifying investment securities, and
management fees paid by its members.
3
%
Qualifying Gross Income Percentage for the Taxable Year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.
Check if a nonresident owner actively participates in the day-to-day management of the QIP. Please provide the nonresident
owner’s name and tax identification number below.
5.
Check if the QIP invests in the qualifying investment securities of any entity majority-owned by a nonresident member. Please
provide the nonresident owner’s name and tax identification number below.
6.
Check if any nonresident owner of the QIP is also a QIP. Please provide the nonresident owner’s name and tax identification
number below.
7.
Check if the entity, at any time during the taxable year, had as an owner or member a person who is other than a United States
Person, as defined in 26 U.S.C. §7701. Please provide the nonresident owner’s name and tax identification number below.
Name: _______________________________________________________________________________________________________
Tax ID: ______________________________________________________________________________________________________
I certify that for this tax period this entity meets the criteria as a Qualified Investment Partnership as required by §40-18-24.2, Code of
Alabama 1975. Further, under penalties of perjury I certify that I have examined this certification and to the best of my knowledge it is
true, correct, and complete.
Signature of
Owner/Partner/Member: ___________________________________________________________ Date: ________________________
Title: ___________________________________________________________________________
In order to be considered valid, this certification must be timely filed with the Alabama partnership income tax return for the
taxable year.
ADOR
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