Form Fts-10c - Tax Return For Assessment Of Shares Of Domestic Corporations - 1999
ADVERTISEMENT
1A
D
R
FTS-10C
Rev. 8/98
LABAMA
EPARTMENT OF
EVENUE
1999
Tax Return for
Assessment of Shares of Domestic Corporations
For Tax Year Beginning October 1, 1998 Ending September 30, 1999
This return, along with required financial data and certificates of assessment, shall be filed by all domestic corporations
unless specifically exempt by law to the Alabama Department of Revenue at the address shown on the back of this return.
RECEIVING STAMP
LEGAL CORPORATION NAME (PLEASE TYPE OR PRINT)
STREET ADDRESS
THIS SPACE FOR DEPARTMENT USE ONLY
CITY, STATE, AND ZIP
COUNTY
ACCOUNT NUMBER
PLEASE SEE INSTRUCTIONS ON BACK OF RETURN
Federal Employer Identification Number
Industrial Code
Penalty 10%
1
1 Date of incorporation:
________________________________________________
(month / day / year)
2
2 Total number of shares of capital stock outstanding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
$
3 Par value of each share . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
$
4 Fair and reasonable cash value of each share . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
$
5 Value of shares as shown by the books . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
$
6 Value of shares as shown by the last report of the officers to the shareholders . . . . . . . . . . . . . . . . . . .
7
7 Date of last sale of stock:
______________________________________________
(month / day / year)
8
8 Number of shares sold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
$
9 Price paid for shares. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
10 By whom sold ___________________________________________________________________
11
11 To whom sold ____________________________________________________________________
12 Annual dividend declared on stock for the last four years as follows:
For 1995: ____________________________
For 1997: ____________________________
12
For 1996: ____________________________
For 1998: ____________________________
13
$
13 Amount of surplus on hand October 1, 1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
$
14 Amount of undivided profits not included in surplus October 1, 1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
AFFIDAVIT
THE STATE OF ALABAMA, _________________________________ COUNTY.
I, _________________________________________________________________________________ do hereby certify that I am
the __________________________________________________ of the above named corporation, and that the foregoing statements
Title of Officer
made by me are full, true, and correct.
X ___________________________________________________ ( _____ ) _______________
Signature of Officer
Telephone Number
Sworn to and subscribed before me this the ___________ day of _____________________________, _______.
X _________________________________________________________________________
Tax Assessor or Deputy Assessor
NOTE: A corporation is not required to furnish a list of stockholders and numbers of shares held by each if, in lieu thereof, it signs
the following:
AGREEMENT: The above named corporation through its ________________________________________ hereby agrees to pay
Title of Officer
the tax assessed against the shares of stock in said corporation.
X _________________________________________________________________________
Signature of Officer
DO NOT WRITE BELOW THIS LINE
16
16 Total value of all shares of stock. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(
)
17
17 Direct investments in U.S. Government Obligations . . . . . . . . . . . . . . . .
(
)
18
18 Book value of tangible property in other states . . . . . . . . . . . . . . . . . . . .
(
)
19
19 Book value of pollution control assets . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(
)
20
20 Book value of goods, wares, and merchandise held for sale . . . . . . . .
(
)
21
21 Book value of motor vehicles otherwise assessed . . . . . . . . . . . . . . . . .
(
)
22
22 Cost of capital stock owned in domestic corporations . . . . . . . . . . . . . .
(
)
23
23 Cost of capital stock owned in foreign corporations . . . . . . . . . . . . . . . .
(
)
24
24 Book value of industrial development board property. . . . . . . . . . . . . . .
(
)
25
25 One half the book value of leasehold improvements . . . . . . . . . . . . . . .
(
)
(
)
26a
26b
26 S Corporation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
27
27 Total value of all shares of stock remaining for assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
28
28 20% Assessment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(
)
29
29 Total value of assessed tangible property located in Alabama . . . . . . .
XXXXXXXXXXXXXXX
This county assessment . . . . . . . . . . . . ________________________
30
30 Value of shares of stock subject to assessment . . . . . . . . . . . . . . . . . . .
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