Form 480.70(Oe) - Informative Return For Income Tax Exempt Organizations - Puerto Rico Department Of The Treasury Page 2

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Form 480.70(OE) Rev. 05.00
Income Tax Exempt Organizations - Page 2
Questionnaire (continued)
Yes No
Yes No
During the year, have the incorporation articles, internal
19.
During the year, was the organization liquidated, dissolved or
17.
regulations or similar documents been amended? If you
finished? If you checked yes, submit detail............................
(17)
(19)
answered yes, submit copy of such changes.
20.
Is the organization controlled or does it control other institution?
(20)
Have you had any source of income or had any activities
If you checked yes, indicate its name:
18.
not informed previously to the Secretary of the Treasury?......
______________________________________________
(18)
(Submit detail of the activities).
Part II
Income, Dues, Contributions, Etc.
1.
Dues, assessments, etc. from members, excluding services and other charges properly included under line 8
00
(see instructions Parts II and III) ...............................................................................................................................
(1)
00
2.
Dues, assessments, etc. from affiliated organizations (see instructions Parts II and III) .....................................
(2)
00
3.
Contributions, gifts, grants, etc. received (see instructions Parts II and III) .........................................................
(3)
00
4.
Patronage dividends (or patronage refund) received (see instructions Parts II and III) .......................................
(4)
00
5.
Interest ...................................................................................................................................................................
(5)
00
6.
Dividends .................................................................................................................................................................
(6)
00
7.
Rents .......................................................................................................................................................................
(7)
8.
Gross income from business activities including exempt income from a registered investment company or real estate
investment trust (specify which one) (See General Information, 3rd paragraph)
00
(a) ______________________________________________________________________________________
(8a)
00
(b) ______________________________________________________________________________________
(8b)
00
(c) ______________________________________________________________________________________
(8c)
00
(d) ______________________________________________________________________________________
(8d)
00
(e) ______________________________________________________________________________________
(8e)
00
9.
Total lines 1 through 8(e) .....................................................................................................................................
(9)
Part III
Disposition of Income, Dues, Contributions, Etc.
A. Expenses attributable to income (Lines 7 and 8. See instructions Parts II and III):
00
10.
Cost goods sold (in case of farming cooperatives, purchases for or advances to patrons) ......................................
(10)
11.
Compensation to officers, directors, fiduciaries, etc. (include statement showing name, position, salary and time
00
devoted to position) ....................................................................................................................................................
(11)
00
12.
Salaries, wages and commissions. Number of employees involved
...................................................
(12)
00
13.
Interest ...................................................................................................................................................................
(13)
00
14.
Taxes (such as property, income, social security, unemployment, etc.) ....................................................................
(14)
00
15.
Rents ...........................................................................................................................................................................
(15)
00
16.
Depreciation (and depletion) ..................................................................................................................................
(16)
17.
Miscellaneous expenses (indicate nature):
00
(a) ____________________________________________________________________________________
(17a)
00
(b) ____________________________________________________________________________________
(17b)
00
(c) ____________________________________________________________________________________
(17c)
00
18.
Dues, assessments, etc. to affiliated organizations ...................................................................................................
(18)
B. Contributions:
19.
Contributions, gifts, grants, etc. paid (state to whom they were paid):
00
(a) ___________________________________________________________________________________
(19a)
00
(b) ___________________________________________________________________________________
(19b)
00
(c) _______________________________________________________________________________________
(19c)
C. Other dispositions:
20.
Benefit payments to or for members or their dependents:
00
(a) Death, sickness, hospitalization, disability, life insurance or pensions benefits.......................................................
(20a)
00
(b) Other benefits ..................................................................................................................................................
(20b)
00
21.
Dividends (other than patronage dividends) and other distributions to members, shareholders, or depositors ........................
(21)
00
22.
Cash patronage dividends (or patronage refund) (for farming cooperatives only) ................................................
(22)
23.
Patronage dividends (or patronage refund) in stocks, credits, and other evidence of equity or indebtedness (for
00
farming cooperatives only) .............................................................................................................................................
(23)
00
24.
Additions to surplus and reserves (include itemized schedule) .............................................................................
(24)
00
25.
Total of lines 10 through 24 (see instructions Parts II and III) .......................................................................................
(25)
00
26.
Excess (deficit) for the year (subtract line 25 from line 9) ..............................................................................................
(26)
00
27.
Balance of funds at the beginning of the year ................................................................................................................
(27)
00
28.
Other changes in balance of funds (submit schedule) .........................................................................................
(28)
00
29.
Balance of funds at the end of the year ........................................................................................................................
(29)

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