Schedule F Individual - Other Income Page 2

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Schedule F Individual - Page 2
Rev. 05.02
Part II
Corporate Dividends and Partnerships Distributions
34
Column A
Column B
Employer's Identification
Account Number
Payer's name
Number
Not subject to Withholding
Subject to Withholding
(01)
00
00
(02)
00
00
(03)
00
00
(04)
00
00
(05)
00
00
(06)
00
00
(07)
00
00
Less: Exempt amount from dividends distributed under Act No. 26 of 1978
(
00
)
00
(11)
00
1.
Total distributed amount (Transfer the total of Column B to Part 2, line 2E of the return )......................................................................
(08)
00
2.
Special tax: 10% of Column A (Enter in Part 4, line 19 of the return)....................................................................................................
(09)
00
3.
Tax withheld (Submit Form 480.6B. Enter on Schedule B Individual, Part III, line 5) ..........
........................................................................
(10)
NOTE: If you elected to include the distribution indicated in Column A as ordinary income, do not consider line 2 and transfer the total of
line 1, Column A to Part 2, line 2D of the return.
Part III
Special Partnerships Profits
40
(SUBMIT SCHEDULE R - SEE INSTRUCTIONS)
Payer's name
Profits
Employer's Identification Number
(01)
00
(02)
00
(03)
00
Total Profits (Transfer to Part 2, line 2B of the return)...............................
.......................................................................................................................................................
(04)
00
Part IV
Profits from Subchapter N Corporations of Individuals
Payer's name
Profits or Losses
Employer's Identification Number
(05)
00
(06)
00
(07)
00
00
Net profit
Less: Losses from previous years
(Submit Schedule)
(
)
00
00
Total Profits
(Transfer to Part 2, line 2F of the return. If it is less than zero, enter zero).................................................................................................................................
(08)
Conservation Period: Ten (10) years

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