Form Dr-350111 - Intangible Tax Self_audit Worksheet Page 2

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DR-350111
Intangible Tax
R. 06/07
Self-Audit Worksheet –
Page 2 of 8
Name of taxpayer:
Social security number:
Name of spouse:
Social security number:
TAx cALcULATION WORkShEET
[complete only one (1) column below]
Filing status
Step 1
INDIVIDUAL
JOINT
bOx A
bOx b
bOx c
bOx D
If your taxable assets from
Schedule A, Line 5 are:
$100,000 or less
Greater than $100,000
$200,000 or less
Greater than $200,000
6A.
Taxable assets
Step 2
$________________
$________________
$________________
$________________
(Schedule A, Line 5)
6B.
Times tax rate
X______
X______
X______
X______
Step 3
6C.
Gross tax
$________________
$________________
$________________
$________________
(Multiply Line 6A x Line 6B)
6D.
Less exemption
– $______
– $______
– $______
– $______
6E.
Net tax
Step 4
$________________
$________________
$________________
$________________
(subtract Line 6D from Line 6C.)
If less than zero, enter (-0-)
cARRY TOTAL TAx DUE TO SchEDULE A, LINE 6, PAgE 1
TAx RATES AND ExEMPTION SchEDULE
INDIvIDUAL
JOINT
Assets $ 100,000 or Less Assets Greater than $ 100,000 Assets $ 200,000 or Less
Assets Greater than $ 200,000
TAX YEAR
RATE
EXEMPTION
RATE
EXEMPTION
RATE
EXEMPTION
RATE
EXEMPTION
1984-1990
.001
$
20.00
.0010
$
20.00
.001
$
40.00
.0010
$
40.00
1991-1992
.001
$
20.00
.0015
$
70.00
.001
$
40.00
.0015
$
140.00
1993-1999
.001
$
20.00
.0020
$ 120.00
.001
$
40.00
.0020
$
240.00
2000
.001
$
20.00
.0015
$
70.00
.001
$
40.00
.0015
$
140.00
2001-2003
.001
$
20.00
.0010
$
20.00
.001
$
40.00
.0010
$
40.00
INDIvIDUAL - assets any amount
JOINT - Assets any amount
2004-2005
.0010
$ 250.00
.0010
$
500.00
2006
.0005
$ 125.00
.0005
$
250.00
ENTER APPROPRIATE RATE AND EXEMPTION IN ShADED AREAS IN ThE TAX CALCULATION WORKShEET ABOvE
bONDS
Face Value
Interest
Maturity
Number
Per $100.00
Total Taxable
schedule b
Per bond
Rate
Date
Owned
Value
Amount
Name of issuer, series
(A)
(b)
(c)
(D)
(E)
January 1, _____
List alphabetically, one bond per line
9. TOTAL bONDS
Attach additional schedule if necessary. Photocopies of this schedule are acceptable.
cARRY ThIS AMOUNT TO SchEDULE A, LINE 1, PAgE 1 .......................................................................................... 9.

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