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Tennessee Department of Revenue

Franchise and Excise Tax - Family-Owned Noncorporate Entity

Disclosure of Activity Instructions

Identifying information

Please attach additional schedules as necessary to disclose

Enter the entity name and address.

all industrial and commercial real estate rental received by

Your exempt account number can be found on the

the exempt entity for the reporting period. The entity's

cover letter you received with this form. If you do not

name and account number/FEIN should be on all

know your exempt account number, enter your FEIN and

attachments.

write É F EINÉ next to the number.

Example: 62-1234567 FEIN

Other Passive Income

Check the box next to each source of income received and

enter the annual gross receipts received from each source.

Organization Structure

In order to qualify as an exempt family-owned

noncorporate entity, 95% of the ownership units of the

Non-Passive Income

entity must be owned by members of the family. Please

List the source and amount of non-passive income received

identify all members or partners and their respective

during the reporting period. Attach additional schedules as

ownership interest percentage in the entity. You must

necessary to disclose all non-passive income. The entity's

also give their relationship as defined in Tenn. Code

name and account number/FEIN should be on all

Ann. § 67-4-2008(a)(11)(B)(i).

attachments.

Attach additional schedules as necessary to disclose all

Sign and Mail

members or partners in the exempt entity. The entity's

Please sign and date the Disclosure of Activity form

name and account number/FEIN should be on all

attesting to accuracy of the information provided. The

attachments.

form should be mailed to:

Tennessee Department of Revenue

Passive Investment Income - Industrial and commercial

FONCE Disclosure

P.O. Box 190644

real estate rental

Description and address of property - provide a brief

Nashville, TN 37219-0644

description of the property being rented and the street

address of such property.

Relevant Definitions

Examples: Duplex, 800 State St., Anywhere, TN

Retail Store, 123 Maple St., Anywhere, TN

"Industrial and commercial property" includes all property

of every kind used, directly or indirectly, or held for use,

Name of lessee(s) - Provide the name(s) of the entity or

for any commercial, mining, industrial, manufacturing,

individual who is leasing the property that is generating

trade, professional, club whether public or private,

passive investment income. If you are leasing a building

nonexempt lodge, business, or similar purpose, whether

with multiple tenants, such as an apartment building, you

conducted for profit or not. All real property that is used, or

may write É v arious tenantsÉ in the space provided. If you

held for use, for dwelling purposes that contains two (2) or

are leasing to a single lessee or a limited number of

more rental units is hereby defined and shall be classified

lessees, please identify them.

Example:

Various

as É i ndustrial and commercial property.

unrelated tenants

"Farm property" includes all real property that is used, or

Check the box provided if any of the lessees are affiliated

held for use, in agriculture, including, but not limited to,

with or related to the exempt entity.

growing crops, pastures, orchards, nurseries, plants, trees,

Example: ? John Smith, partner in exempt entity

timber, raising livestock or poultry, or the production of

Jones Properties, LLC, common owners

raw dairy products.

Total Appraised Value - Enter the appraised value used

"Residential property" includes all real property that is

for property tax purposes.

used, or held for use, for dwelling purposes and that

contains not more than one (1) rental unit. All real property

Gross receipts - Enter the annual gross receipts received

that is used, or held for use, for dwelling purposes, but that

for the rental of the property. É G ross receiptsÉ are defined

contains two (2) or more rental units, is defined and shall

as all receipts from whatever sources derived before any

be classified as "industrial and commercial property".

deductions.

The completed form should be mailed to: Tennessee Department of Revenue, FONCE Disclosure, P. O.

Box 190644, Nashville, TN 37219-0644. If you have questions or need assistance, you can call the

Department at (615) 253-0700. Callers within Tennessee but outside the Nashville calling area call (800)

397-8395. You may also e-mail the department at TN.Revenue@state.tn.us or browse our web site at

Franchise And Excise Tax - Family-Owned Noncorporate Entity - Disclosure Of Activity - Tennessee Department Of Revenue Form Page 2

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