DEPARTMENT USE ONLY
AMENDED ALASKA CORPORATION NET
FORM
ENV
611X
INCOME TAX RETURN
For the calendar year 20____ or the taxable year beginning
FSN
____________, 20____ and ending ____________, _______
EIN
EIN Used On Original Return, if different
Name
Name Used On Original Return, if different
Mailing Address
Contact Person
Contact Telephone Number
City
State
Zip Code
Title
Contact Fax Number
Contact Email Address
Check if under audit at this time by the Alaska Department of Revenue
SCHEDULE A - NET INCOME TAX SUMMARY
A
B
C
As originally reported
Net change
Correct
or as adjusted
(explain on Schedule C)
amount
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1. Apportionable income
1
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2. Alaska apportionment factor
2
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3. Alaska apportioned income
3
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4. Non-business income (loss)
4
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5. Alaska Items
5
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6. Alaska income. Add lines 3-5
6
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7. Alaska net operating loss deduction
7
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8. Alaska taxable income
8
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9. Alaska income tax
9
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10. Other taxes
10
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11. Total tax. Add lines 9-10
11
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12. Film production tax credit
12
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13. Other Alaska incentive credits
13
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14. Federal-based credits (see instructions)
14
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15. Net Alaska income tax (net of lines 12-14)
15
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16. Payments and credits from Schedule B, Line 11
16
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17. Tax due (overpaid). Subtract line 16 from line 15
17
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18. Interest on amount on line 17 from _____/_____/_____ to _____/_____/_____
18
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19. Total amount due
19
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20. If line 16 is greater than line 15, column C, enter overpayment (as a negative number)
20
Overpayment is to be:
refunded
or
credited to tax year ended
I declare, under penalty of perjury, that I have examined this amended return, including accompanying
Check if the DOR may discuss this return
schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete.
with the preparer (see instructions)
Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Officer’s Signature
Date
Title
DEPT. USE ONLY
Preparer’s Signature
Date
Check if
Preparer’s SSN or PTIN
Refund
self-employed
Preparer firm’s name (or yours if
EIN
Phone
CFWD
self-employed) and address
City
State
Zip Code
Dept Use Only
Approved
Validation Number:
FORM
611X
0405-611X Rev 01/13 - page 1