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TENNESSEE DEPARTMENT OF REVENUE

R0011301

QUARTERLY FRANCHISE, EXCISE TAX DECLARATION

Account No.

FAE

Beginning

Taxable

Each taxpayer having a combined fran-

172

Year

chise and excise tax liability of $5,000 or more

Ending

for the current and prior tax years must make

four quarterly estimated tax payments. The

payments are due on the 15th day of the

fourth, sixth, and ninth months of the current

year and the first month of the succeeding

year.

TAXPAYER NAME AND MAILING ADDRESS

Make your check payable to the Tennessee

NAME ___________________________________________________________________________________

Department of Revenue and mail to:

BOX (STREET) ____________________________________________________________________________

Tennessee Department of Revenue

Andrew Jackson State Office Building

CITY _____________________________________________________________________________________

500 Deaderick Street

Nashville, TN 37242

STATE _____________________

ZIP _________________________________

For assistance, you may call in-state toll

free 1-800-342-1003 or (615) 253-0700.

REMINDERS

1. All franchise, excise tax forms are required to be filed electronically. An electronic version of this form is available online at

apps.tn.gov/fnetax. Tenn. Code Ann. Section 67-1-115 (b) authorizes the Commissioner of Revenue to require a manual handling

fee up to $25 on paper filings.

2. If you choose to file on paper, please use due care to select the correct quarterly voucher, since payments are applied to the

applicable quarterly installment based on the prenumbered vouchers.

3. Enter the amount from Line 4 of the worksheet to the "Amount of Payment" field on the voucher.

4. If Line 4 of the worksheet is zero, please do not file the voucher.

ROUND TO NEAREST DOLLAR

1. Estimated Franchise, Excise tax liability ........................................................................................

____________________________

2. Less: Franchise, Excise Tax Credits and prior year overpayments .............................................

____________________________

3. Net Estimated Franchise, Excise tax liability ................................................................................

____________________________

4. Estimated payment (one fourth of Line 3) ...................................................................................

____________________________

KEEP UPPER PORTION FOR YOUR RECORDS-RETURN COPY BELOW

TENNESSEE DEPARTMENT OF REVENUE

Due Date:

FAE

QUARTERLY FRANCHISE, EXCISE TAX DECLARATION

If your account number is not preprinted or unknown, enter federal identification or social

BEGINNING

ENDING

security number

Taxable

172

Year

ACCOUNT NUMBER

(FEIN/

SSN)

AMOUNT OF

PAYMENT

FOR OFFICE

USE ONLY

INTERNET (9-16)

RV-R0011301

Form Fae 172 - Quarterly Franchise, Excise Tax Declaration - Tennessee Department Of Revenue

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