Form 765 - Unified Nonresident Individual Income Tax Return - 2011 Page 3
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3*VA765L111888*
Tax Year
Unified Nonresident Income Tax Return
Virginia Schedule L
FORM 765
List of Participants
FEIN
Name of Pass-Through Entity
Identify the Participants
SSN
Name / Address
Allocation %
Guaranteed Payment
Amount
i i
_______________________
.
____________
___________________
1.
_______________________
_______________________
i i
_______________________
.
____________
___________________
2.
_______________________
_______________________
i i
_______________________
.
____________
___________________
3.
_______________________
_______________________
i i
_______________________
____________
.
___________________
4.
_______________________
_______________________
i i
_______________________
____________
.
___________________
5.
_______________________
_______________________
i i
_______________________
.
____________
___________________
6.
_______________________
_______________________
i i
_______________________
.
____________
___________________
7.
_______________________
_______________________
i i
_______________________
____________
.
___________________
8.
_______________________
_______________________
i i
_______________________
____________
.
___________________
9.
_______________________
_______________________
i i
_______________________
.
____________
__________________
10.
_______________________
_______________________
Substitute versions of this form that are produced using computer software must provide the same information in the same four
column format as shown on the official version of this form. Minimum font size is 10 point.
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