Form Ie-N - Intangible Expense - Notice Of Deduction

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Tennessee Department of Revenue
File this form
Intangible Expense – Notice of Deduction
with tax return
(FAE 170 or FAE 174)
Form IE-N
or email to
Intangible.Expense@tn.gov
Taxable Year
Taxpayer Name
Account No/FEIN/SSN
Federal Form No.
Expense Deducted on Federal Form Line No.
Type of Expense
Name of Affiliate
FEIN
This form should only be filed in instances where the intangible expenses paid to the affiliate come within the exceptions or – safe harbors – found at Tenn. Code
Ann. § 67-4-2006(b)(2)(N)(i)(a)-(c). If such expenses are paid to more than one affiliate, a separate notice should be completed for each affiliate.
Intangible expense, or portion thereof, was: (Check all that apply)
(a) Paid, accrued, or incurred to an affiliate in a foreign nation that is a signatory to a comprehensive income tax treaty
with the United States;
Foreign nation
Line 1: Total “Foreign Nation” Deduction
(b) Paid, accrued, or incurred to an affiliate when the affiliate during the same taxable year, has directly or indirectly paid,
accrued or incurred such portion to an entity that is not an affiliate;
Name of non-affiliate
FEIN
Line 2: Total “Non-Affiliate” Deduction
(c) Paid, accrued, or incurred to an affiliate doing business in, or deriving income from, a state that imposes a tax on or
measured by net income and, under that state’s law, the affiliate is subject to an income tax in that state. (see
instructions for details;
State
Tax Type / Form Name
Amount
Ratio
Apportioned Amount
A ____________
____________________
__________________ ___________
________________
B ____________
____________________
__________________ ___________
________________
C ____________
____________________
__________________ ___________
________________
D ____________
____________________
__________________ ___________
________________
Line 3: Total “Tax Paid” Deduction
______________________
(Sum Lines A-D, “Apportioned Amount” column)
Line 4: Total Intangible Expense Deduction within Safe Harbors
(Sum lines 1-3)
_____________________
POWER OF ATTORNEY Check YES if this
I certify, under penalty of perjury, that the information provided in and with this form is true and correct to the
taxpayer’s signature certifies that this tax
best of my knowledge and understanding.
preparer has the authority to execute this form
on behalf of the taxpayer and is authorized to
_____________________________________________
___________________
______________
receive and inspect confidential tax information
Signature of Taxpayer, Officer or Representative
Title
Date
and to perform any and all acts relating to
_____________________________________________
___________________
______________
respective tax matters.
YES
Tax Preparer’s Signature
Preparer’s PTIN
Date
RV-F1406701

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