Form 480.20(Cpt) - Employees Owned Special Corporation Informative Tax Return (Page 4 of 4) in pdf

Employees Owned Special Corporation - Page 4

Form 480.20(CPT) Rev. 03.99

Questionnaire

YES NO

Did you submit financial statements certified by a CPA

Did the Employees Owned Special Corporation keep

licensed in Puerto Rico? (required if the gross income

any part of its records on a computerized system during

exceeds $1,000,000. See instructions) .............................

(7)

this year? .........................................................................

(1)

Did the Employees Owned Special Corporation claim

The Employees Owned Special Corporation books are

deductions for expenses connected with:

in care of:

(a) Vessels? ..........................................................................

(8a)

Name:

(b) Living expenses?............................................................

(8b)

Address:

outside Puerto Rico or the United States?.................

(8c)

Did the corporation had earnings or profits related to periods

when it was not an Employees Owned Special Corporation,

Indicate if the corporation had partially exempt income

or received in liquidations or reorganizations?..............................

(9)

under the following acts:

Enter amount: ________________________________

Act No. 52 of 1983

Act No. 26 of 1978

Did the Employees Owned Special Corporation distribute

10.

Act No. 78 of 1993

Act No. 8 of 1987

profits during the taxable year?..................................................

(10)

Act No. 57 of 1963

Is the Employees Owned Special Corporation a member

11.

Indicate if this year you elected an exemption provided by:

of other Employees Owned Special Corporation?...............

(11)

Act No. 52 of 1983

Act No. 26 of 1978

Name:

_____________________________________

Act No. 78 of 1993

Act No. 8 of 1987

Employer's identification number:

________________

Act No. 57 of 1963

Indicate the proportion: _________________________

Indicate accounting method used:

Enter the amount of exempt interest: _______________

12.

Cash

Accrual

Did the corporation made charitable contributions to

13.

Other (specify): ____________________________

municipalities? .....................................................................

(13)

Did the corporation file the following documents?

Enter the amount: _______________________________

(a)

Informative Returns (Forms 480.5, 480.6A, 480.6B).

(6a)

Enter the amount of members: ___________________

14.

(b)

Withholding Statement (Form 499R-2/W-2PR) ........

(6b)

Number of new jobs: ___________________________

15.

OATH

We, the undersigned, president (or vice president or other principal officer) and treasurer (or assistant treasurer) of the corporation for which

this Employees Owned Special Corporation Informative Tax Return is made, each for himself, declare under the penalty of perjury, that this

return (including schedules and statements attached) has been examined by us, and to the best of our knowledge and belief, is a true,

correct and complete return, made in good faith, pursuant to the Puerto Rico Internal Revenue Code of 1994, as amended, and the

Regulations thereunder.

____________________________________________

President's or vice president's signature

Treasurer's or assistant treasurer's signature

Affidavit No. _________________

NOTARY

SEAL

Sworn and subscribed before me by ___________________________________ , of legal age, ___________________ [civil status],

_______________ [occupation], and resident of _______________________, ___________, and by _____________________________,

of legal age, ____________________ [civil status], ______________________ [occupation], and resident of _____________,_____,

personally known by me or identified by means of____________________, in ___________________, _______________, this _______th

day of _______________, _____.

_________________________________________

________________________________________

Title of the person administering oath

Signature of the person administering oath

Specialist's Use Only

I declare under the penalty of perjury that this return (including schedules and statements attached) has been examined by me and to the best of my knowledge and

belief is a true, correct and complete return. The declaration of the person that prepares this return is with respect to the information received, and this information

may be verified.

Registration No.

Date

Specialist's Social Security

Specialist's name (Print letter)

Check if self

employed

number

Firm's name

Employer's Identification

number

Specialist's signature