Form Psa - Alabama Business Privilege Tax Return And Annual Report - 2004
ADVERTISEMENT
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3A
D
R
LABAMA
EPARTMENT OF
EVENUE
2004
PSA
Alabama Business Privilege Tax Return and Annual Report
Type of business entity (must check one):
For Balance Sheet Year:
Beginning
C Corporation
S Corporation
Other
______/______/________
Regular C Corporation
Regular S Corporation
Real Estate Investment Trust
(mm/dd/yyyy)
Insurance Company (See definitions)
Insurance Company (See definitions)
Limited Liability Entity
Ending
Financial Institution Group Member
Financial Institution Group Member
Business Trust
______/______/________
(mm/dd/yyyy)
LLE Taxed as Corporation
LLE Taxed as Corporation
Disregarded Entity
CY (Calendar Year)
LEGAL ENTITY NAME (PLEASE TYPE OR PRINT)
FY (Fiscal Year)
SY (Short Year)
MAILING ADDRESS
FEIN
CHECK BOX IF APPLICABLE
CITY, STATE, AND ZIP CODE
(This Space For Use By Alabama Department of Revenue)
Initial Return
Amended Return (see
FEDERAL BUSINESS CODE NUMBER (NAICS)
DOES THIS REPRESENT A CHANGE
instructions, part IX)
Yes
OF ADDRESS?
RECEIVING STAMP
1a County of incorporation or organization for all Alabama entities. . . . . . .
1a
1b State or country of incorporation or organization for all foreign entities
1b
2a Date of qualification or registration in Alabama for foreign entities. . . . .
2a
2b Date of incorporation or organization for all entities . . . . . . . . . . . . . . . .
2b
(
)
2c Telephone number of the taxpayer . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2c
3 Name of registered agent in Alabama. . . . . . . . . . . . . . . . . . . . . . . . . . .
3
A
FEIN or social security number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
T
Street address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
T
A
City, state and zip code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
C
4 Name of president or primary member/partner. . . . . . . . . . (update
)
4
H
Social security number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
C
Street address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
H
E
City, state and zip code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
C
5 Name of secretary or secondary member/partner . . . . . . . (update
)
5
K
Social security number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
H
Street address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
E
R
City, state and zip code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
E
6 Kind of business done in Alabama . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
7 Principal place of business in Alabama. . . . . . . . . . . . . . . . . . . . . . . . . .
7
City, state and zip code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8 Kind of business done generally . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
9 Principal office and place of business if outside State of Alabama. . . . .
9
City, state and zip code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
FOR DEPARTMENT USE ONLY
10 Secretary of State annual report fee $10 (corporations only) . . . . . . . . .
10
11 Less: Annual report fee previously paid for this period . . . . . . . . . . . . . .
11
12 Net annual report fee due (line 10 less line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
13 Privilege tax due (Schedule B, line 26) . . . . . . . . . . . . . . . . . . . . . . . . .
13
14 Less: Privilege tax previously paid for this period. . . . . . . . . . . . . . . . . .
14
15 Net privilege tax due (line 13 less line 14) . . . . . . . . . . . . . . . . . . . . . . .
15
16 Privilege tax penalty due (see instructions). . . . . . . . . . . . . . . . . . . . . . .
16
17 Privilege tax interest due (see instructions) . . . . . . . . . . . . . . . . . . . . . .
17
18 Total privilege tax due (add lines 15, 16 and 17) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18
19 Net tax due (add lines 12 and 18) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
19
20 Payment due with return if line 19 is positive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
20
21 Amount to be refunded if line 19 is negative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21
22 If payment made through Electronic Funds Transfer (EFT) check this box and
see instructions – Part X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Make check payable to: Alabama Department of Revenue
Telephone number: (334) 353-7923
Web Site:
Mail to: Alabama Department of Revenue, Business Privilege Tax Section, P.O. Box 327431, Montgomery, AL 36132-7431
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