Form Fae 174 - Franchise And Excise Financial Institution Tax Return printable pdf download

TENNESSEE DEPARTMENT OF REVENUE

FRANCHISE AND EXCISE FINANCIAL INSTITUTION TAX RETURN

FEIN or SSN

Account No.

Taxable Year

FAE

Beginning:

Due Date

174

Ending:

}

AMENDED RETURN, please check

the box at right.

CHECK APPROPRIATE BLOCK(S):

j. Single Member LLC/Division

Tennessee Domestic Corporation

of parent (see instructions)

Foreign Corporation

L P

}

FINAL RETURN for termination or with-

S Corporation

LLP

drawal, please check box at right.

Insurance Company

RLLP

LLC

PRLLP

PLLC

Business Trust

}

Payment for this return was sent via

Single Member LLC/individual

Not-For-Profit

EFT, please check the box at right.

Single Member LLC/corporation

Other

________________

Single Member LLC/general partnership

Taxpayer has made an election to cal-

}

culate net worth per the provisions of

T.C.A. 67-4-2103 (g)-(i), please check

the box at right.

Enter the principal business activity code (NAICS)

listed in federal IRC instructions that best de-

scribes the principal business activity in Tennes-

see.

Date Tennessee

If you use a paid

Operations Began

preparer and do not

want forms mailed to

you next year, check

box at right.

SCHEDULE A - COMPUTATION OF FRANCHISE TAX

DOLLARS

CENTS

1. Total net worth from Schedule F1, Line 6 or F2, Line 5 ........................................................................................ (1) ______________________________

2. Total real & tangible personal property from Schedule G, Line 15 ....................................................................... (2) ______________________________

3. Franchise tax (25¢ per $100.00 or major fraction thereof on the greater of Lines 1 or 2; minimum $100.00) .. (3) ______________________________

SCHEDULE B - COMPUTATION OF EXCISE TAX

4. Income subject to excise tax from Schedule J, Line 35 ........................................................................................... (4) ______________________________

5. Excise tax (6.5% of Line 4) ..................................................................................................................................... (5) ______________________________

6. Add: Recapture of excise tax credit from Schedule T, Part 2 ................................................................................. (6) ______________________________

7. Net excise tax due (Line 5 plus Line 6) ................................................................................................................ (7) ______________________________

SCHEDULE C - COMPUTATION OF TOTAL TAX DUE OR OVERPAYMENT

8. Total Franchise and Excise taxes - Add lines 3 and 7 ..........................................................

(8) ______________________________

9. Deduct: Total credit from Schedule D, Line 7 (cannot exceed Line 8) ...............................

(9) ______________________________

10. Subtotal: Line 8 less Line 9 (if Line 9 exceeds Line 8, enter 0 here) ....................................

(10) ______________________________

11. Deduct: Total payments from Schedule E, Line 7 ..............................................................

(11) ______________________________

12. Penalty (5% for each 30-day period of delinquency not to exceed 25%; minimum penalty is $15)

(12) ______________________________

13. Interest (12.00% per annum on taxes unpaid by the due date) ............................................................................ (13) ______________________________

14. Penalty on estimated franchise, excise tax payments ........................................................................................... (14) ______________________________

15. Interest on estimated franchise, excise tax payments ........................................................................................... (15) ______________________________

16. Total amount due (overpayment) - Add lines 10, 12, 13, 14, and 15, less Line 11 ......................................... (16) ______________________________

If overpayment reported on Line 16, complete A and/or B:

Credit to next year’s tax $ ___________________________

Refund $ ______________________

Under penalties of perjury, I declare that I have examined this report, and to the best of my knowledge and belief, it is true, correct, and complete.

POWER OF ATTORNEY - Check YES if this

taxpayer's signature certifies that this tax preparer

_______________________________________________________________

__________________

_______________________________

Taxpayer's Signature

Date

Title

has the authority to execute this form on behalf of

the taxpayer and is authorized to receive and in-

_______________________________________________

_____________