Form Pte-C - Nonresident Composite Payment Return - 2005 Page 3
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3Reset Schedule
A
D
R
Schedule PTE-CK1
LABAMA
EPARTMENT OF
EVENUE
Entity’s FEIN
10/05
For the year January 1 - December 31, 200___ or other tax year beginning ___________________, 200___ ending ___________________, 200___
0
(D) Owner’s/Shareholder’s
(G) Non-Corporate
(H) Corporate
(A) Non-Resident Owner’s/Shareholder’s Name,
(B) Social Security
(C) Entity
Share of Nonseparately
(E) Guaranteed
(F) Total Income
Owner’s/Shareholder’s
Owner’s Share of
Stated Income +
Share of Tax Due
Street Address, City, State, and ZIP
Number/FEIN
Type
Payments
(Col. D + E)
Tax Due (Col. F X 6.5%)
Portfolio Income
(Col. F X 5%)
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13 Add lines 1 through 12, enter here and on page 2, line 14, columns (D) through (H) . . . . . . . . . . . . . . . .
Additional page _________
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