Form Pse - Extension Request For The Alabama Business Privilege Tax Return, Corporate Shares Tax Return, And Annual Report - 2000

A

D

R

LABAMA

EPARTMENT OF

EVENUE

Extension Request For The

FORM

Alabama Business Privilege Tax Return,

2000

PSE

Corporate Shares Tax Return, and Annual Report

12/99

This Form Must Be Completed And Returned On Or Before March 15, 2000.

RECEIVING STAMP

LEGAL ENTITY NAME (PLEASE TYPE OR PRINT)

MAILING ADDRESS

EXTENSION CODE

CITY, STATE, AND ZIP CODE

(This Space For Use By Alabama Department of Revenue)

FEIN

DOES THIS REPRESENT A CHANGE

Yes

No

OF ADDRESS?

Type of business entity (check one) :

C Corporation

S Corporation

Other

Regular C Corporation

Regular S Corporation

Real Estate Investment Trust

Insurance Company

Insurance Company

Limited Liability Entity

Utility/Railroad Company

Utility/Railroad Company

Business Trust

Financial Institution

Financial Institution

Disregarded Entity

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. . . . . . . . . . . . . . . . . . . . . . . .

3

FEIN or social security number . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Street address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

City, state and zip code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4 Name of president or primary member/partner . . . . . . . . . . . . . . . . .

4

Social security number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Street address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

City, state and zip code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5 Name of secretary or secondary member/partner . . . . . . . . . . . . . .

5

Social security number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Street address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

City, state and zip code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6 Kind of business done in Alabama . . . . . . . . . . . . . . . . . . . . . . . . . .

6

7 Principal place of business in Alabama. . . . . . . . . . . . . . . . . . . . . . .

7

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 Privilege tax due* (minimum $100) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11

12 Shares tax due* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12

13 Payment due (Electronic Funds Transfer is not available this year for this tax) . . . . . . . . . . . . . . . . . .

13

*To avoid late payment penalties, 90% of the actual liability must be paid with this extension request.

I __________________________________________________________ the __________________________________________________________ , do hereby swear (or

NAME OF OFFICER, PRIMARY MEMBER, OR PARTNER

TITLE OF OFFICER, PRIMARY MEMBER, OR PARTNER

affirm), depose, and say, under penalties of perjury, that this return for the annual report and the collection of the privilege and share taxes made to the Alabama Department

of Revenue, is true, full, and correct.

_________________________________ ____________________________________________________________________ (____________)_____________________

DATE

SIGNATURE OF OFFICER, PRIMARY MEMBER, OR PARTNER

TELEPHONE NUMBER