Franchise And Excise Tax - Family-Owned Noncorporate Entity - Disclosure Of Activity - Tennessee Department Of Revenue Form
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TENNESSEE DEPARTMENT O F REVENUE
Franchise and Excise Tax
Family-Owned Noncorporate Entity
Disclosure of Activity
Entity Name
Exempt Account #
Address
Tax Year
2007
City
State
Zip Code
Organizational Structure
Member/Partner Name
Ownership Percentage
Relationship
1.
2.
3.
4.
5.
Attach additional schedules if necessary. Include the entity name and exempt account number on any attachment.
Passive Investment - Industrial & Commercial* Real Estate Rental
Total Appraised
Description and
Name of Lessee(s)
Gross Receipts
Value
(based on
Address of Property
(Check box if affliliated with
or related to the exempt entity)
property tax records)
Example: Duplex, 800 State St., Anywhere, TN
$75,000
$15,000
Various unrelated tenants
Example: Retail Store, 123 Maple St., Anywhere, TN
$45,000
John Smith, partner in exempt entity
$500,000
Attach additional schedules if necessary. Include the entity name and exempt account number on any attachment.
Other Passive Investment Income
Check all that apply
Source of Income
Source of Income
Gross Receipts
Gross Receipts
Royalties
Gain on sale/exchange of stock
Dividends
Gain on sale/exchange of securities
Rent from residential property*
Interest
Annuities
Rent from farm property*
Other
Rent from tangible personal property
(Explain)
Non-Passive Income
Source of Income
Gross Receipts
Total Non-Passive Income
$
Attach additional schedules if necessary. Include the entity name and exempt account number on any attachment.
Return complete form to:
The information provided on this disclosure form is true to the best of my knowledge and belief.
Tennessee Department of Revenue
FONCE Disclosure
P.O. Box 190644
Nashville, TN 37219-0644
Sign:
Date:
*See reverse side for relevant definitions
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