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Form Et-C - Election And Payment Of Fee For Filing A Consolidated Financial Institution Excise Tax Return

FORM

For Tax Year

LABAMA

EPARTMENT OF

EVENUE

ET-C

Election and Payment of Fee for

REV. 6/07

Filing a Consolidated Financial Institution Excise Tax Return

Name of Parent Corporation

FEIN (Parent Corporation)

Mailing Address

Amount Due – $6,000.00

City

State

Zip

(Official Use Only)

Signature of Officer

Title

Telephone Number

(

)

As provided in Chapter 16, Title 40, Code of Alabama 1975 as amended, the above company, as the common parent corporation

of the controlled group of financial institutions listed below elects to file with them a Consolidated Return of Financial Intitutions

Excise Tax for the State Tax Year shown above. The payment of the $6,000.00 fee for the privilege of filing as required by Section

40-16-3 as referenced above must be remitted electronically.

COMPLETE THE INFORMATION BELOW FOR THE CONTROLLED CORPORATIONS

NAME

ADDRESS (CITY, STATE, AND ZIP)

FEIN

(Electronic Only)

Due Date:

Remittance must be made electronically.

Form ET-C and remittance must be received by

This form is available for e-file. Both the voucher and payment must be remitted

April 15th of the current tax year.

electronically. Visit our Web site:

ADOR

Form Et-C - Election And Payment Of Fee For Filing A Consolidated Financial Institution Excise Tax Return