Form Tc-65 - Schedule G Partner/member Listing

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TC-65 Schedule G
TC-65 G 2008
65805
Partner/Member Listing
Employer Identification Number: _ __________________
Complete all information for each partner/member.
Enter “G” if general partner or managing member. Enter “L” if limited partner or non-managing member.
Enter entity code:
C = Corporation
N = Nonprofit Corp
P = Gen’l Partnership
R = LLP
I = Individual
S = S Corp
B = LLC
L = Limited Partnership
T = Trust
_ _
_ _
___ _ _ ____ _
_ __ _________________
__________
____ _ __ __ _
G/L
Code
SSN or EIN
Partner/member name
Date affiliated
Telephone number
_ ___ ________________
__________
____ _ __ __ _
Partner/member street address
Date withdrawn
Percent of Utah income
_ ___ ________________
City, state, ZIP
_ _
_ _
___ _ _ ____ _
_ __ _________________
__________
____ _ __ __ _
G/L
Code
SSN or EIN
Partner/member name
Date affiliated
Telephone number
_ ___ ________________
__________
____ _ __ __ _
Partner/member street address
Date withdrawn
Percent of Utah income
_ ___ ________________
City, state, ZIP
_ _
_ _
___ _ _ ____ _
_ __ _________________
__________
____ _ __ __ _
G/L
Code
SSN or EIN
Partner/member name
Date affiliated
Telephone number
_ ___ ________________
__________
____ _ __ __ _
Partner/member street address
Date withdrawn
Percent of Utah income
_ ___ ________________
City, state, ZIP
_ _
_ _
___ _ _ ____ _
_ __ _________________
__________
____ _ __ __ _
G/L
Code
SSN or EIN
Partner/member name
Date affiliated
Telephone number
_ ___ ________________
__________
____ _ __ __ _
Partner/member street address
Date withdrawn
Percent of Utah income
_ ___ ________________
City, state, ZIP
_ _
_ _
___ _ _ ____ _
_ __ _________________
__________
____ _ __ __ _
G/L
Code
SSN or EIN
Partner/member name
Date affiliated
Telephone number
_ ___ ________________
__________
____ _ __ __ _
Partner/member street address
Date withdrawn
Percent of Utah income
_ ___ ________________
City, state, ZIP
_ _
_ _
___ _ _ ____ _
_ __ _________________
__________
____ _ __ __ _
G/L
Code
SSN or EIN
Partner/member name
Date affiliated
Telephone number
_ ___ ________________
__________
____ _ __ __ _
Partner/member street address
Date withdrawn
Percent of Utah income
_ ___ ________________
City, state, ZIP
Duplicate this form if you need more space.
IMPORTANT: To protect your privacy, use the "Clear form" button when you are finished.
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