Form Psa - Alabama Business Privilege Tax Return, Corporate Shares Tax Return, And Annual Report - 2001
ADVERTISEMENT
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42001
RECEIVING STAMP
A
D
R
LABAMA
EPARTMENT OF
EVENUE
Alabama Business Privilege Tax Return,
PSA
Corporate Shares Tax Return, and Annual Report
LEGAL ENTITY NAME (PLEASE TYPE OR PRINT)
For Tax Year:
Beginning
______/______/________
MAILING ADDRESS
FEDERAL BUSINESS CODE NUMBER (NAICS)
(mm/dd/yyyy)
Ending
CITY, STATE, AND ZIP CODE
(This Space For Use By Alabama Department of Revenue)
______/______/________
(mm/dd/yyyy)
FEIN
DOES THIS REPRESENT A CHANGE
CY (Calendar Year)
Yes
OF ADDRESS?
FY (Fiscal Year)
Type of business entity (check one):
SY (Short Year)
C Corporation
S Corporation
Other
Regular C Corporation
Regular S Corporation
Real Estate Investment Trust
CHECK BOX IF APPLICABLE
Initial Return
Insurance Company (See definitions)
Insurance Company (See definitions)
Limited Liability Entity
(See Schedules E and F)
Utility/Railroad Company
Utility/Railroad Company
Business Trust
Final Return
Financial Institution Group Member
Financial Institution Group Member
Disregarded Entity
Amended Return
LLE Taxed as Corporation
LLE Taxed as Corporation
1 State or country of incorporation or organization . . . . . . . . . . . . . . .
1
2a Date of qualification or registration in Alabama for foreign entities. .
2a
2b Date of incorporation or organization for all entities . . . . . . . . . . . . .
2b
3 Name of registered agent in Alabama. . . . . . . . . . . . . . (update
)
3
FEIN or social security number . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Street address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
A
City, state and zip code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
T
4 Name of president or primary member/partner . . . . . . . (update
)
4
T
A
Social security number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
C
Street address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
H
City, state and zip code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
C
5 Name of secretary or secondary member/partner . . . . (update
)
5
H
E
Social security number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
C
Street address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
K
City, state and zip code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
H
6 Kind of business done in Alabama . . . . . . . . . . . . . . . . . . . . . . . . . .
6
E
R
7 Principal place of business in Alabama. . . . . . . . . . . . . . . . . . . . . . .
7
E
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) . . . . . .
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11 Less: Annual report fee previously paid for this period . . . . . . . . . . .
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12 Net annual report fee due (line 10 minus line 11). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
13 Privilege tax due (Schedule B, line 26 or Schedule E, line 11). . . .
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 Shares tax due (Schedule F, line 25). . . . . . . . . . . . . . . . . . . . . . . .
19
20 Less: Shares tax previously paid for this period . . . . . . . . . . . . . . . .
20
21 Net shares tax due (line 19 less line 20). . . . . . . . . . . . . . . . . . . . . .
21
22 Shares tax penalty due (see instructions) . . . . . . . . . . . . . . . . . . . . .
22
23 Shares tax interest due (see instructions). . . . . . . . . . . . . . . . . . . . .
23
24 Total shares tax due (add lines 21, 22 and 23) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24
25 Net tax due (add lines 12, 18 and 24) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
25
26 Payment due with return if line 25 is positive (Electronic funds transfer is not available.). . . . . . . . . . . .
26
27 Amount to be refunded if line 25 is negative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
27
Make check payable to : Alabama Department of Revenue
Mail to: Alabama Department of Revenue, Business Privilege and Corporate Shares Tax Section, P.O. Box 327431, Montgomery, AL 36132-7431
Telephone number: (334) 353-7923
Web Site:
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