Form 4i - Insurance Company Franchise Tax Return - 2005 Page 2
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2005 Form 4I
Page
Schedule C1 – Nonrefundable Credits
Schedule A – Computation of Adjusted Federal
Taxable Income (See instructions, page 3)
1 Manufacturer’s sales tax credit (Sch. Z,
1 Federal taxable income . . . . . . . . . . . . .
1
line 13) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
2 Dairy investment credit (Sch. DI, line 9) .
2
2 Additions to federal taxable income:
3 Research expense credit (Sch. R, line 30)
3
a Loss carryforward deducted in the
calculation of federal taxable income
2a
4 Development zones research credit
carryforward . . . . . . . . . . . . . . . . . . . . . . .
4
b Dividend income received to the
5 Research facilities credit (Sch. R, line 34)
5
extent used as a deduction in deter-
mining federal taxable income . . . . . .
2b
6 Community development finance credit .
6
c Interest income that is not included
7 Development zones jobs credit carry-
in federal taxable income . . . . . . . . .
2c
forward . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
8 Development zones sales tax credit carry-
d State taxes accrued or paid . . . . . . .
2d
forward . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
e Extraterritorial income exclusion . . . .
2e
9 Development zones investment credit
f Federal depreciation/amortization in
(Sch. DC, line 15) . . . . . . . . . . . . . . . . . .
9
excess of Wisconsin depreciation/
10 Development zones location credit carry-
amortization (attach schedule) . . . . .
2f
forward . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
g Amount by which the federal basis
11 Development zone capital investment
of assets disposed of exceeds the
credit (Sch. DC, line 23) . . . . . . . . . . . . . 11
Wisconsin basis (attach schedule) . .
2g
12 Development zones day care credit
h Additional deduction for insurers
carryforward . . . . . . . . . . . . . . . . . . . . . . . 12
required to discount unpaid losses . .
2h
13 Development zones environmental
remediation credit carryforward . . . . . . . 13
i Other (attach schedule) . . . . . . . . . . .
2i
14 Development zones credit (Sch. DC,
3 Add lines 1 through 2i . . . . . . . . . . . . . .
3
line 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
4 Subtractions from federal taxable income:
15 Technology zone credit (Sch.TC, line 8)
15
a Wisconsin dividends received
16 Early stage seed investment credit (Sch.
deduction (attach Schedule Y) . . . . .
4a
VC, line 8) . . . . . . . . . . . . . . . . . . . . . . . . 16
b Wisconsin depreciation/amortization
17 Supplement to federal historic credit
in excess of federal depreciation/
(Sch. HR, line 7) . . . . . . . . . . . . . . . . . . . 17
amortization (attach schedule) . . . . .
4b
18 Add lines 1 through 17 (enter on page 1,
line 19) . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
c Amount by which the Wisconsin
basis of assets disposed of exceeds
the federal basis (attach schedule) .
4c
Schedule C2 – Refundable Credits
d Other (attach schedule) . . . . . . . . . . .
4d
1 Farmland preservation credit (Sch. FC,
line 18) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
5 Add lines 4a through 4d . . . . . . . . . . . .
5
2 Farmland tax relief credit (Sch. FT,
6 Subtract line 5 from line 3. This is
line 6) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
adjusted federal taxable income (enter
3 Add lines 1 and 2 (enter on page 1,
on page 1, line 1) . . . . . . . . . . . . . . . . . .
6
line 26) . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
Additional Information Required
1 Person to contact concerning this return:
Phone #:
Fax #:
2 City and state where books and records are located for audit purposes:
3 Attach a list of your solely owned limited liability companies. Did you include the incomes of these entities in this return?
Yes
No
a Attach a list of corporations in which you own, directly or indirectly, 50% or more of the outstanding voting stock.
4
b Have the incomes of these affiliated corporations been included in this return?
Yes
No
5 a Attach a list of corporations, individuals, partnerships, trusts, or associations which own 50% or more of your outstanding voting stock.
b Have the incomes of these organizations been included in this return?
Yes
No
6 If your corporation has been involved in any reorganization during the period covered by this return, attach a detailed explanation.
7 Did you purchase any taxable tangible personal property or taxable services for storage, use, or consumption in Wisconsin without
payment of a state sales or use tax?
Yes
No
If yes, you owe Wisconsin use tax. See instructions, page 2, for how to report use tax.
8 Did any adjustments made by the Internal Revenue Service to your income for prior years become finalized during this year?
Yes
No
If yes, see General Instructions, page 2, and indicate years adjusted:
Under penalties of law, I declare that this return and all attachments are true, correct, and complete to the best of my knowledge and belief.
Signature of Officer
Title
Date
Preparer’s Signature
Preparer’s Federal Employer ID Number
Date
Attach a copy of your federal return, related schedules, and annual statement.
Make your check payable to and mail your return to: Wisconsin Department of Revenue, P.O. Box 8908, Madison, WI 53708-8908.
Return to Page 1
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