Form A-213 - Corporation Schedule A - Petition For Compromise Of Taxes
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1Corporation Schedule A – Petition for Compromise of Taxes
(To be submitted in duplicate with Form A-212)
IMPORTANT If a corporation submits offer in compromise, furnish
information requested below from income tax returns, as adjusted, for
1. Statement of Income
past 2 years and from records for current year from January 1 to date.
Year 20
Year 20
Jan 1 to
A Gross Income
$
$
$
1. Gross sales or receipts
. .
(less returns & allowances)
2. Cost of goods sold . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Gross profit – trading or manufacturing . . . . . . . . . .
4. Gross profit – from other sources . . . . . . . . . . . . . .
5. Interest income . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6. Rents and royalties . . . . . . . . . . . . . . . . . . . . . . . . . .
7. Gains and losses . . . . . . . . . . . . . . . . . . . . . . . . . . .
8. Dividends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9. Other income
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(specify)
$
$
$
10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Total Income
B Deductions
$
$
$
1. Compensation of officers . . . . . . . . . . . . . . . . . . . . .
2. Salaries and wages (not deducted elsewhere) . . . .
3. Rents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4. Repairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5. Bad debt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6. Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7. Taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8. Losses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9. Dividends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10. Depreciation and depletion . . . . . . . . . . . . . . . . . . .
11. Contributions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12. Advertising . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13. Other deductions
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(specify)
$
$
$
14. . . . . . . . . . . . . . . . . . . . . . . . . . Total Deductions
$
$
$
C Net Income (Loss)
$
$
$
D Nontaxable Income
$
$
$
E Unallowable Deductions
2. Salaries Paid to Principal Officers and Dividends Distributed
IMPORTANT If corporation submits offer in compromise, show salaries paid to principal officers for past 3 years and amounts
distributed in dividends, if any, during and since the taxable years covered by this offer.
Year 20
Year 20
Year 20
A Salaries paid to (name and title)
1.
$
$
$
President
2.
Vice President
3.
Treasurer
4.
5.
$
$
$
6.
Total Salaries Paid
B Dividends paid
Year 20
Dividend Paid
Year 20
Dividend Paid
Year 20
Dividend Paid
1.
$
1.
$
1.
$
2.
2.
2.
3.
3.
3.
4.
4.
4.
5.
5.
5.
6.
$
6.
$
6.
$
Total
Total
Total
3. Is this corporation in process of liquidation?
Yes
No
4. List principal officers from the beginning of the taxable period covered by this compromise to the present time.
Show the period each person was an officer of this corporation.
Social Security
Years This
% of Total Common
Full Name
Title
Number
Title Held
Shares Held
A-213 (R. 9-06)
Wisconsin Department of Revenue
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