Schedule K-1 (Form 38) - Beneficiary'S Share Of North Dakota Income (Loss), Deductions, Adjustments, Credits, And Other Items - 2011 Page 3

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North Dakota Office of State Tax Commissioner
Final
Amended
North Dakota
Schedule K-1
2011
Calendar year 2011
(Jan. 1 - Dec. 31, 2011)
Corporation's
tax year:
(Form 60)
Fiscal year:
Beginning _______________, 2011
Shareholder's Share of North Dakota Income (Loss),
Ending _______________, 20 ____
Deductions, Adjustments, Credits, and Other Items
Part 3 continued . . .
See separate instructions
9 Geothermal credit - after 12/31/08
Part 1
Corporation information
A Corporation's federal EIN
10 Employer internship program tax credit
11 Microbusiness tax credit
B Corporation's name, address, city, state, and ZIP code
12 Research expense tax credit
13 a Endowment fund tax credit
b Endowment fund contribution adjustment
14 Workforce recruitment credit
Shareholder information
Part 2
15 Credit for wages paid to mobilized employee
C Shareholder's SSN or FEIN (from Federal Schedule K-1)
16 a Angel fund investment credit
D Shareholder's name, address, city, state, and ZIP code
b Angel fund investment credit purchased
(from Federal Schedule K-1)
17 Housing incentive fund credit
Nonresident individual, estate or trust
Part 4
shareholder only - North Dakota income (loss)
E What type of entity is this shareholder? ____________________________
18 Corporation's apportionment factor
F If shareholder is an individual, estate, or trust, shareholder is a:
19 Ordinary income (loss)
Full-year resident
of North Dakota
Part-year resident
of North Dakota
20 Net rental real estate income (loss)
Full-year nonresident of North Dakota
21 Other net rental income (loss)
Yes
No
G Is shareholder included in a composite return?
22 Interest income
H Shareholder's stock ownership percentage: ____________%
23 Ordinary dividends
Part 3
All shareholders - North Dakota adjustments
24 Royalties
and tax credits
25 Net short-term capital gain (loss)
1 Interest from U.S. obligations
26 Net long-term capital gain (loss)
2 Renaissance zone income exemption
27 Net section 1231 gain (loss)
3 New or expanding business exemption
28 Other income (loss)
4 a Renaissance zone: Historic property
preservation/renovation tax credit
29 Section 179 deduction
b Renaissance zone: Renaissance fund
30 Other deductions
organization investment tax credit
31 I.R.C. Section 179 property disposition
gain (loss)
c Renaissance zone: Nonparticipating
property owner credit
Part 5
Nonresident individual shareholder only
5 Seed capital investment tax credit
32 North Dakota distributive share of income
6 Agricultural commodity processing
(loss)
facility investment tax credit
7 Supplier biodiesel or green diesel fuel tax credit
33 North Dakota income tax withheld
8 Seller biodiesel or green diesel fuel tax credit
34 North Dakota composite income tax

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