Form It-20g - Governmental Units And Agencies Gross Income Tax Return
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1Indiana Department of Revenue
Governmental Units and Agencies
FORM
2001
IT-20G
(Do Not Write Above)
Gross Income Tax Return
Federal Identification Number
For the Calendar Year Ending December 31, 2001
State Form 21099
or Fiscal Year Beginning _________/_________/ 2001 and Ending ________/________/______
AA
BB
(R/9-01)
A
Name of Agency
Date last audited
Federal Business Activity Code Number
by the Indiana
Department of
B
H
Revenue
Street Address
County
Indiana Taxpayer Identification Number
D
I
K
C
City
State
Zip Code
Telephone Number
Date Incorporated
(
)
J
E
F
G
L
Schedule A - Gross Income Tax Computation
High Tax Rate
Low Tax Rate
Column A = 1.2% (.012)
Column B = .3% (.003)
GROSS RECEIPTS RECEIVED
1. Gas ................................................................................................
2. Power and light ...............................................................................
3. Water ..............................................................................................
4. Sale of by-products from sewage utility ........................................
5. Concession stand receipts .............................................................
6. Miscellaneous income ....................................................................
7A
7B
7. Totals (add lines 1 through 6) .........................................................
8B
8A
8. Nontaxable receipts (itemize on Schedule B below) ........................
9. Exemption ($83.33 per month, total of columns A and B may not
9B
9A
exceed $1,000) .................................................................................
10.Add lines 8 and 9 for each column .................................................
11.Amounts subject to tax (line 7 minus line 10 of each column) ........
12B
12.Multiply amounts on line 11 by the tax rate for each column .........
12A
.............
13.Total Schedule A gross income tax (add total amounts on line 12A and line 12B)
13
Schedule B - Explanation of Nontaxable Items of Income
DEDUCTED FROM RECEIPTS
Line Number
Item Deducted
Column A
Column B
Totals
Schedule C - Payments and Credits
14. Total quarterly IT-6 or EFT estimated payments (itemize payments below)
Qtr. 1 __________ Qtr. 2 __________ Qtr. 3 __________ Qtr. 4 __________ Enter total ...........
14
15.
Enter extension payment _______ and prior year overpayment credit _______from tax year_______Enter total
b
c
a
15
16. Other credits (attach detailed explanation) .........................................................................................
16
17. Total payments and credits (add lines 14, 15, and 16) ........................................................................
18. Balance of tax due (line 13 minus line 17 - if line 17 is greater than 13, proceed to line 23 and 20) ......
19. If payment is made after the original due date, compute penalty of 10% of line 18 or $5.00, whichever is greater
19
20. Penalty for the underpayment of quarterly tax from Schedule IT-2220 (Attach IT-2220) ....................
20
21. If payment is made after the original due date, add interest (contact the Department for the current interest rate)
21
22. Total tax, penalty, and interest (add lines 18, 19, 20, and 21) ........................................Pay this amount
22
23. Total overpayment (line 17 minus lines 13 and 20) .......................
23
24. Amount of line 23 to be refunded .................................................
24
25. Amount of line 23 to be credited to the following year's estimated account (line 23 minus line 24).....
25
Under penalties of perjury, I declare I have examined this return, including accompanying schedules and statements, and to the best of my
CC
DD
knowledge and belief, it is true, correct, and complete. I authorize the Department to discuss my return with my tax preparer. Yes
Signature of Officer
Date
Print or Type Name
Title
LL
M M
1
Paid Preparer's Name
Preparer's FID, SSN, or PTIN Number
Check Box
Federal I.D. Number
OO
2
Social Security Number
FF
NN
Street Address
Daytime Telephone Number
PTIN Number
3
E-mail address
GG
PP
City
State
Zip+4
Preparer's Signature
HH
EE
II
JJ
KK
Please mail form to: Indiana Dept. of Revenue, 100 North Senate Ave., Indianapolis, IN 46204-2253
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