Form Pte-C - Nonresident Composite Payment Return - 2005 Page 2
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1
2
3Schedule PTE-CK1
A
D
R
LABAMA
EPARTMENT OF
EVENUE
Entity’s FEIN
10/05
0
For the year January 1 - December 31, 200___ or other tax year beginning ___________________, 200___ ending ___________________, 200___
(D) Owner’s/Shareholder’s
(G) Non-Corporate
(H) Corporate
(A) Non-Resident Owner’s/Shareholder’s Name,
(B) Social Security
(C) Entity
(E) Guaranteed
(F) Total Income
Share of Nonseparately
Owner’s/Shareholder’s
Owner’s Share of
Street Address, City, State, and ZIP
Number/FEIN
Type
Stated Income +
Payments
(Col. D + E)
Share of Tax Due
Tax Due (Col. F X 6.5%)
Portfolio Income
(Col. F X 5%)
1
2
3
4
5
6
7
8
9
10
11
12
13
Totals page 2 [columns (D) through (H)] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
Totals from additional pages [columns (D) through (H)] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
Totals [columns (D) through (F)] (lines 13 + 14) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15G
Add lines 13 and 14, column (G) and enter here and on page 1, line 1 Non-Corporate owners/shareholders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
00
15H
Add lines 13 and 14, column (H) and enter here and on page 1, line 1 Corporate owners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
00
IF MORE THAN 12 NON-RESIDENT OWNERS/SHAREHOLDERS, ATTACH ADDITIONAL SHEETS.
Page 2
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