Form 05-364 - Texas Corporation Franchise Tax Report

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REFER TO INSTRUCTIONS
05-149
ON FORM 05-357
b.
(5-99)
TEXAS CORPORATION FRANCHISE TAX REPORT
(For Years 1991 and Prior)
Choose the type of return
a. T Code
e.
f. Due date
c. Taxpayer number
d. Filing period
g. Taxpayer name and tax report mailing address
(Make any necessary name and address changes below)
h.
2 9
00991
Reference
no.
PIR
Federal
attached
return
i.
IF THIS REPORT IS FOR A YEAR PRIOR TO 1984 AND YOU CHOOSE THE OPTION
TO FILE BASED ON ASSETS EVERYWHERE, YOU MUST SUBMIT A COPY OF YOUR
FEDERAL CORPORATE RETURN WITH THIS REPORT.
NO - Proceed to Item 2
1. Is this corporation the survivor of a merger?
YES - Read Instructions BEFORE completing report
Month
Day
Year
(See instructions)
2. Enter accounting year end date
2.
.00
(Whole dollars only)
3. Assets in Texas
3.
.00
(Whole dollars only)
4. Assets everywhere
4.
5. For reports based on assets everywhere, enter tax from the table, then
.
5.
(See instructions)
skip to Item 14.
On all other reports, complete all items.
.00
(Whole dollars only)
6. Gross receipts in Texas
6.
.00
(Whole dollars only)
7. Gross receipts everywhere
7.
.
(Item 6 divided by Item 7)
8. Apportionment factor
8.
.
9. Capital stock - outstanding and in treasury
9.
.
(If deficit, see instructions.)
10. Surplus
10.
.
(Item 9 plus Item 10)
11. Total capital stock and surplus
11.
.
(Multiply Item 11 by Item 8)
12. Net taxable capital and surplus
12.
.
(Multiply Item 12 by $
)
13. Tax on capital and surplus
13.
.
(Enter the larger of Item 13 or $
)
14. TOTAL TAX DUE
14.
.
(See instructions.)
15. Bank credit allowed
15.
.
(See instructions.)
16. Prior payments
16.
.
(Item 14 minus Items 15 and 16)
17. NET TAX DUE
17.
Form 05-149 (5-99)
.
(See instructions)
18. Penalty and interest
18.
.
19. TOTAL AMOUNT DUE AND PAYABLE
(Item 17 plus Item 18)
19.
Taxpayer name
j.
k.
If you have any questions regarding Franchise Tax, you may contact the Texas State Comptroller's field office in your area or call 1-800-252-1381, toll free, nationwide. The
Austin number is 512/463-4600. If you're calling from a Telecommunications Device for the Deaf (TDD), the toll-free number is 1-800-248-4099, or in Austin, 512/463-4621.
Daytime phone
(Area code and no.)
Make the amount in Item 19 payable
I declare that the information in this document and any attachments is true and correct to the
to
STATE COMPTROLLER.
best of my knowledge and belief.
Our mailing address is
Officer, director or authorized agent
Print or type name
Date
111 E. 17th Street
Austin, TX 78774-0100.
T Code
Taxpayer number
Period

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