Form 480.30(Ii)dt - Income Tax Return For Exempt Businesses Under The Puerto Rico Incentives Programs Tourism Development

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Form 480.30(II)DT Rev. 06.12
Liquidator:
Reviewer:
Serial Number
GOVERNMENT OF PUERTO RICO
20____
20____
DEPARTMENT OF THE TREASURY
Field Audited by:
Income Tax Return for Exempt Businesses
under the Puerto Rico Incentives Programs
AMENDED RETURN
Date ______/ ______/ ______
Tourism Development
Payment Stamp
R
M
N
TAXABLE YEAR BEGINNING ON ________________, _______ AND ENDING ON ________________, ________
Employer Identification Number
Taxpayer's Name
Department of State Registry No.
Postal Address
Industrial Code
Municipal Code
Merchant's Registration Number
Zip Code
Location of Principal Industry or Business - Number, Street and Country
Telephone Number - Extension
(
)
Date Incorporated
hange of Address
Type of Principal Industry or Business
C
Day_______/ Month_______/ Year _______
Yes
No
Place Incorporated
Receipt No. __________________________________
Place
Incorporated
eturn
Contracts with Governmental Entities
2012 R
Amount: _____________________________________
E - mail Address of the Contact Person
English
Yes
No
Spanish
Type of Entity
Exempt business operates under:
Indicate if you are a member of a group of related entities
Act 52 of 1983 (Schedule L Incentives) Case No.: __________
Act 74-2010 (Schedule L Incentives) Case No.: __________
Yes
No
Group number
Act 78-1993 (Schedule L Incentives) Case No.: ___________
Act 118-2010 (Schedule Z Incentives) Case No.: ________
00
a)
1.
Tax liability:
Schedule L Incentives, Part II, line 11 .........................................................
(1a)
b)
00
Schedule Z Incentives, Part II, line 5 ...........................................................
(1b)
c)
00
Schedule P Incentives, Part II, line 14 ............................................................
(1c)
d)
Total (Add lines 1(a) through 1(c)) ............................................................................................................
00
(1d)
a)
2.
Less:
Tax withheld at source ..............................................................................................
00
(2a)
b)
Current year estimated tax payments ..........................................................................
00
(2b)
c)
Excess from previous years not included on line 2(b) ....................................................
00
(2c)
d)
Tax withheld on partners distributable share from partnerships and special partnerships ...
00
(2d)
e)
Amount paid with automatic extension of time or with original return .................................
00
(2e)
f)
Tax withheld for professional services (Form 480.6B) ....................................................
00
(2f)
g)
Tax withheld at source on eligible interest .....................................................................
00
(2g)
h)
Total payments (Add lines 2(a) through 2(g)) ..............................................................................................................
00
(2h)
3.
Credit for the payment of additional duties on luxury automobiles under Act 42-2005 (See instructions) .........................................
(3)
00
4.
Balance of tax due (If line 1(d) is larger than the sum of lines 2(h) and 3,
00
(a)
enter the difference here, otherwise, on line 6) ....................................
Tax .................................
(4a)
00
(b)
Interest ............................
(4b)
00
(c)
Surcharges ......................
(4c)
(d)
Total (Add lines 4(a) through 4(c)) ......................................
(4d)
00
5.
Addition to the Tax for Failure to Pay Estimated Tax (Schedule T Incentives, Part II, line 21) ...........................................................
(5)
00
6.
Excess of tax withheld or paid (See instructions) .......................................................................................................................
(6)
00
7.
Amount paid with this return (Add lines 4(d) and 5 less line 6) .......................................................................................................
00
(7)
8.
Amount overpaid to be credited to estimated tax for 2012 ..............................................................................................................
(8)
00
9.
Contribution to the San Juan Bay Estuary Special Fund ..............................................................................................................
(9)
00
10.
Contribution to the Special Fund for the University of Puerto Rico ....................................................................................................
(10)
00
11.
Amount to be refunded ............................................................................................................................................................
(11)
00
OATH
We, the undersigned, president (or vice-president, or other principal officer) and treasurer (or assistant treasurer), or agent of the corporation for which this income tax
return is made, each for himself declare under penalty of perjury, that this return (including schedules and statements attached) has been examined by us, and to the best
of our knowledge and belief, is a true, correct, and complete return, made in good faith, pursuant to the Puerto Rico Internal Revenue Code of 2011, as amended, and the
Regulations thereunder.
____________________________________________
___________________________________
____________________________________________
President's or vice-president's signature
Agent
Treasurer's or assistant treasurer's signature
SPECIALIST'S USE ONLY
I declare under penalty of perjury that this return (including schedules and statements attached) has been examined by me, and to the best of my knowledge and belief is a true, correct,
and complete return. The declaration of the person who prepares this return is with respect to the information received, and this information may be verified.
Registration number
Date
Self-employed specialist
Specialist's name (Print)
4P
Employer identification number
Firm's name
Specialist's signature
Zip code
Address
NOTE TO TAXPAYER
Indicate if you made payments for the preparation of your return:
Yes
No. If you answered "Yes", require the Specialist’s signature and registration number.
Retention Period: Ten (10) years

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