Form 611n - Application For Tentative Refund - 2009
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1STATE OF ALASKA
611N
Department Use Only
CORPORATION NET INCOME TAX
ENVELOPE
Application for Tentative Refund
Federal EIN
EIN Used on original return, if different
Name
Name used on original return, if different
Address
Phone number
Fax number
City
State
Zip +4
Contact phone number
E-mail address
Contact person
Title
Check if under Audit at this time by the Alaska Department of Revenue
1
This application is to carry back:
a. Net operating loss
b. Net capital loss
2.
Loss year
Tax Year ended
Computation of Decrease
FSN:
FSN:
FSN:
3rd preceding tax year
2nd preceding tax year
1st preceding tax year
in Tax
(a) before
(b) after Carry
(c) before
(d) after
(e) before
(f) after carry
Carryback
back
carryback
carryback
Carryback
back
3.
Taxable income from Alaska tax return
4.
Net capital loss deduction
5.
Subtract line 4 from line 3
6.
Net operating loss deduction after carryback
7.
Taxable income. Subtract line 6 from line 5
8.
Income Tax
9.
Credits
10. Other taxes
11. Net income tax. Subtract line 9 from line 8 and
add line 10
12. Net payments. (Total previous payments less
total previous refunds, credits, penalties and
interest
13. Enter amounts from line 11, columns (b), (d)
and (f)
14. Net overpayment. Subtract line 13 from line 12
15. Total refund claimed
I declare, under penalties of perjury, that I have examined this application and accompanying schedules and statements, and to the best of my knowledge and belief it is
true, correct, and complete. Preparer’s declaration is based on all information of which preparer has any knowledge.
Officer’s signature
Date
Title
Preparer’s signature
Date
Preparer’s SSN or PTIN
Check if Self-Employed
Firm’s name
EIN
check if DOR may dicuss this return
with the preparer (see Instructions)
Firm’s address
City
State
Zip + 4
Validation#
CFWD
Mail to: ALASKA DEPARTMENT OF REVENUE
REFUND
TAX DIVISION
PO BOX 110420
APPROVED
JUNEAU AK 99811-0420
611N
DATE
Retain a copy for your records
0405-611N Rev 12/09 • page 1
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