Form Ft 1120fi - Corporation Franchise Tax Report Form For Financial Institutions - 2010
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4Please staple report. Do not staple check.
hio
Department of
FT 1120FI
Reset Form
Rev. 7/09
Taxation
2010 Corporation Franchise Tax Report for Financial Institutions
Based upon calendar year 2009 or other taxable year beginning
,
and ending
, 2009.
If this is an amended report, check the box (if the amended report refl ects a refund, attach form FT REF).
Ohio franchise tax I.D. number
Corporation name
0
Ohio charter or license number
Address (if address change, check box)
Federal employer I.D. number
City
State
ZIP code
North American Industry Classifi cation System
(NAICS Code)
Statutory Agent
Corporate Offi cers
Check the box if all the below-reported corporate offi cers are the same as were
Check the box if both the below-reported statutory agent and address are the
same as were reported on the 2009 franchise tax report.
reported on the 2009 franchise tax report.
Name
President
Address
Secretary
City, state, ZIP code
Treasurer
Instructions for this form are
Schedule A — Computation of Franchise Tax
Whole Dollars Only
on our Web site at tax.ohio.gov.
00
1. Net value of stock (from Schedule E, line 7 or, if applicable, from Schedule F, line 6) ..............................1.
.
2. Apportionment ratio (from Schedule D-1, line 4 or Schedule D-2) ............................................................2.
00
3. Taxable value (line 1 x line 2) ....................................................................................................................3.
00
4. Tax on net worth basis (.013 x line 3, but not less than the minimum fee) ................................................4.
00
5. Total nonrefundable credits (from Schedule A-1, line 6) ............................................................................5.
00
6. Tax due after nonrefundable credits (line 4 minus line 5, but not less than the minimum fee)..............6.
00
7. Overpayment carryforward from 2009 .......................................................................................................7.
00
8. Estimated payments made in tax year 2010: E
, ER
, EX
........8.
00
9. Refundable credits ....................................................................................................................................9.
00
10. Total payments and refundable credits (lines 7, 8 and 9), minus previously claimed refunds, if any ......10.
00
11. Tax due (line 6 minus line 10) .................................................................................................................. 11.
00
12. Interest
, Penalty
, Total interest and penalty ...............................................12.
00
13. Balance due (make payable to Ohio Treasurer of State). Check box if payment made by EFT .....13.
00
14. Overpayment ...........................................................................................................................................14.
00
15. Amount of line 14 to be credited to tax year 2011 estimated tax (if this is an amended report, enter -0-) ......15.
00
16. Amount of line 14 to be refunded (if this is an amended report, attach form FT REF) ........................... 16.
Mail with remittance to: Ohio Department of Taxation, P.O. Box 27, Columbus, Ohio 43216-0027
Declaration/Signatures (an offi cer or managing agent of the corporation must sign this declaration)
I declare under penalties of perjury that this report (including any accompany-
its money or property for or in aid of or opposition to a political party, a candi-
ing schedule or statement) has been examined by me and to the best of my
date for election or nomination to public offi ce, or a political action committee,
knowledge and belief is a true, correct and complete return and report and that
legislation campaign fund or organization that supports or opposes any such
this corporation has not, during the preceding year, except as permitted by
candidate or in any manner used any of its money for any partisan political
Ohio Revised Code section (R.C.) 3517.082, 3599.03 and 3599.031, directly
purpose whatever, or for reimbursement or indemnifi cation of any person for
or indirectly paid, used or offered, consented or agreed to pay or use any of
money or property so used.
Date
Signature of offi cer or managing agent
Title
Date
Signature of preparer other than taxpayer based on all information of which preparer
Title
has knowledge. See general instructions, Item #14.
For Department Use Only
Date Received
Check Amount
Processing Code
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