Form 04-611x - Amended Alaska Corporation Net Income Tax Return Page 2
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1
2PART II. EXPLANATION OF CHANGES
PART III. APPLICATION FOR TENTATIVE REFUND
BASED ON CARRYBACK OF NET OPERATING LOSS OR CAPITAL LOSS
Name
Federal EIN
Telephone Number
Mailing Address
Fax Number
City
State
Zip Code
E-Mail Address
Contact Person
Title
Contact Telephone Number
Name used on original return,
Is the corporation currently under audit
YES
NO
if different from above
by the Alaska Department of Revenue?
1.
This application is to carry back:
a.
Net operating loss
b.
Net capital loss
2.
Loss year ..............................................
Tax Year ended
DEPARTMENT
USE
ONLY
FSN:
FSN:
FSN:
F
H
Taxpayer Completes The Following:
3rd preceding tax year
2nd preceding tax year
1st preceding tax year
Computation of Decrease
(a)
(b)
(c)
(d)
(e)
(f)
Before
After
Before
After
Before
After
in Tax
Carryback
Carryback
Carryback
Carryback
Carryback
Carryback
3. Taxable income from tax return ..............................
4. Net capital loss deduction .......................................
5. Subtract line 4 from line 3 .......................................
6. Net operating loss deduction after carryback .......
7. Taxable income. Subtract line 6 from line 5 ...........
8. Income Tax ...............................................................
9. Credits ......................................................................
10. Other taxes ..............................................................
11. Net income tax. Subtract line 9 from line 8
and add line 10 ........................................................
12. Net payments. (Total previous payments
less total previous refunds, credits, penalties
and interest) .............................................................
13. Enter amounts from line 11, columns (b),
(d) and (f) ................................................................
14. Net Overpayment. Subtract line 13 from line 12 ....
15. Total refund claimed .............................................................................................................................................................
I declare, under penalties of perjury, that I have examined this application and accompanying schedules and statements,
and to the best of my knowledge and belief it is true, correct, and complete. If prepared by a person other than the taxpayer,
DEPT USE ONLY
preparer's declaration is based on all information of which preparer has knowledge.
C F W D
Officer's
Date
Title
Signature
REFUND
Preparer's
Date
Check if
Preparer's SSN or PTIN
q
Signature
self-employed
APPROVED
Firm's name (or
EIN
yours if self-employed)
DATE
and address
Zip Code
DEPT USE ONLY
Validation Number:
Form 04-611N Webform (Rev 01/03)
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