Schedule F Individual - Other Income - 2004 Page 2
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3Schedule F Individual - Page 2
Rev. 05.04
Part II
Corporate Dividends and Partnerships Distributions
34
Column A
Column B
Employer's Identification
Account Number
Payer's name
Number
Not subject to withholding
Subject to withholding
(01)
00
00
(02)
00
00
(03)
00
00
(04)
00
00
(05)
00
00
(06)
00
00
00
Total distributed amount ......................................................................
(07)
00
1.
...................................................................................................................................
(
)
Less: Exempt amount from dividends distributed under Act No. 26 of 1978 ....................................................................................................................................
00
2.
Total (Transfer the total of Column B to Part 2, line 2E of the return )................................................................................................................................................
00
3.
(10)
Special tax: 10% of Column A (Enter in Part 4, line 19 of the return).......................................................................................................................................
4.
(08)
00
Tax withheld (Submit Form 480.6B. Enter on Schedule B Individual, Part III, line 5) ..........
5.
....................................................................................
(09)
00
NOTE: If you elected to include the distribution indicated in Column A as ordinary income, do not consider line 4 and transfer the total of
line 1, Column A to Part 2, line 2D of the return.
Part III
Special Partnerships Profits
(SUBMIT SCHEDULE R - SEE INSTRUCTIONS)
40
Profits
Payer's name
Employer's Identification Number
(01)
00
(02)
00
(03)
00
Total Profits (Transfer to Part 2, line 2B of the return)...............................
.................................................................................................................................................................................
00
(04)
Part IV
Profits from Subchapter N Corporations of Individuals
Profits or Losses
Payer's name
Employer's Identification Number
(05)
00
(06)
00
(07)
00
Net profit
00
Less: Losses from previous years
(Submit Schedule)
(
)
00
00
Total Profits
(Transfer to Part 2, line 2F of the return. If it is less than zero, enter zero)...................................................................................................................................................................
(08)
Part V
Distributions and Transfers from the Retirement Saving Accounts Program
Column A
Column B
Column C
Description
Distributions under
Lump-sum distributions
Transfers under
($10,000 or more)
Section 1169B
$10,000
1.
Total distributed or transferred (Transfer the amount of Column A to Part 2, line 2G of the return) ....................................................
(09)
00
00
(10)
00
(11)
2.
Tax on distributions or transfers (10% tax of Column B or C. Enter in Part 4, line 23 of the return) ...........................................................................................................................................
00
(12)
Conservation Period: Ten (10) years
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