Tax Disclosure Report Form November - 2016

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FEDERAL IDENTIFICATION

FILING FOR MARCH 1, 2017

TDR.8

NO. _____________________

The Commonwealth of Massachusetts

William Francis Galvin

Secretary of the Commonwealth

One Ashburton Place, Boston, Massachusetts 02108-1512

TAX DISCLOSURE REPORT

Corporations

1. Exact name of corporation: ____________________________________________________________________________________

2. Location, including street address, of the corporation’s principal office: ___________________________________________________

3. In the case of corporations that file combined returns, list the names and full addresses of all those corporations:

I, _________________________________________, the undersigned *Treasurer / *Assistant Treasurer, of the above-named

corporation, do hereby certify that all the information contained herein is true and correct as of the date shown below.

SIGNED UNDER THE PENALTIES OF PERJURY, this __________ day of________________________________ , 20 ___________.

__________________________________________________________________________________ , *Treasurer / *Assistant Treasurer

(signature)

TAX DISCLOSURE REPORT

Corporations

4. Tax year for which the report is filed: .............................................................................................................. _____________________

5. Gross receipts or sales: ................................................................................................................................... $ _____________________

6. Gross profit: ................................................................................................................................................. $ _____________________

–OR–

Excess tax credit: ........................................................................................................................................... $ _____________________

7. Income subject to apportionment: ................................................................................................................. $ _____________________

8. Income taxable in Massachusetts: .................................................................................................................. $ _____________________

9. Total non-income tax excise: .......................................................................................................................... $ _____________________

10. Excise due: .................................................................................................................................................. $ _____________________

11. Set forth the amount of each tax credit taken: ____________________________________________________________________

*Delete the inapplicable words.

Note: You may furnish supplemental information in accordance with M.G.L. Ch 62C, s.83(j) on separate 8

x 11 sheets of white bond paper.

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tdrcorp 11/10/16