Texas Franchise Tax Report Form - Comptroller Of Public Accounts Page 3
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6TEXAS FRANCHISE TAX REPORT - Page 1
RESET FORM
PRINT FORM
05-158-A
(Rev. 4-09/3)
Tcode
13270 Final
FILING REQUIREMENTS
Taxpayer number
Report year
Due date
Taxpayer name
Secretary of State file number
or Comptroller file number
Mailing address
City
State
Country
ZIP Code
Plus 4
Blacken circle if the
address has changed
Blacken circle if Total Revenue is adjusted for
Blacken circle if this is a combined report
Blacken circle to request a Certificate of Account Status
Tiered Partnership Election, see 171.1015.
** If not twelve months, see instructions for annualized revenue
m
m
d
d
y
y
m
m
d
d
y
y
SIC code
NAICS code
Accounting year
Accounting year
begin date **
end date
REVENUE
(Whole dollars only)
0 0
,
,
,
,
.
1. Gross receipts or sales
1.
0 0
,
,
,
,
.
2. Dividends
2.
0 0
,
,
,
,
.
3. Interest
3.
0 0
,
,
,
,
.
4. Rents
4.
0 0
,
,
,
,
.
5. Royalties
5.
0 0
,
,
,
,
.
6. Gains/losses
6.
0 0
,
,
,
,
.
7. Other income
7.
0 0
,
,
,
,
.
8. Total gross revenue
8.
(Add Items 1 thru 7)
0 0
,
,
,
,
.
9. Exclusions from gross revenue
9.
(Item 8 minus Item 9)
0 0
,
,
,
,
.
10. TOTAL REVENUE
10.
(If less than zero, enter 0)
COST OF GOODS SOLD
(Whole dollars only)
0 0
,
,
,
,
.
11. Cost of goods sold
11.
0 0
,
,
,
,
.
12. Indirect or administrative overhead costs
12.
(Limited to 4%)
0 0
,
,
,
,
.
13. Other
13.
(See instructions)
0 0
,
,
,
,
.
14. TOTAL COST OF GOODS SOLD
14.
(Add items 11 thru 13)
COMPENSATION
(Whole dollars only)
0 0
,
,
,
,
.
15. Wages and cash compensation
15.
0 0
,
,
,
,
.
16. Employee benefits
16.
0 0
,
,
,
,
.
17. Other
17.
(See instructions)
0 0
,
,
,
,
.
18. TOTAL COMPENSATION
18.
(Add items 15 thru 17)
Texas Comptroller Official Use Only
PROCEED TO NEXT PAGE
VE/DE
PM Date
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