Form Ia Fran Es - Iowa Tax Payments For Financial Institutions - 2004 Page 2
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1
2Iowa Department of Revenue
Franchise Estimated Worksheet
(Keep for your records)
AMENDED
COMPUTATION
ORIGINAL
ONLY
COMPUTATION
$
$
1. Taxable income per federal return (1120) ................................................................................................................. 1.
2. Interest and dividends exempt from federal income tax ........................................................................................... 2.
3. Iowa Franchise Tax deduction on Federal 1120 ....................................................................................................... 3.
4. Other Additions .......................................................................................................................................................... 4.
5. Total Iowa income (add lines 1 through 4) ................................................................................................................ 5.
6. Other Deductions ....................................................................................................................................................... 6.
7. Iowa net operating loss ............................................................................................................................................. 7.
8. Total Deductions (add lines 6 and 7) ........................................................................................................................ 8.
9. IOWA NET INCOME SUBJECT TO FRANCHISE TAX (subtract line 8 from line 5) ............................................... 9.
10. Computed tax (5% of amount on line 9) ................................................................................................................... 10.
11. Minimum Tax ............................................................................................................................................................. 11.
12. Total Tax (add lines 10 and 11) ................................................................................................................................ 12.
13. Minimum Tax carryforward credit .............................................................................................................................. 13.
14. Tax after credit (subtract line 13 from line 12) .......................................................................................................... 14.
(
)
15. Payments previously made for current period estimate tax .................................................................... Use these two lines
15.
16. Unpaid balance .........................................................................................................................................
only if amending
16.
17. Computation of installment ....................................................................................................................................... 17.
(
) last day of the 4th month, enter 1/4 of line 14 ...............................................................
if first installment (
) last day of the 6th month, enter 1/3 of line 14 (line 16 if amending) .............................
is to be filed on
(
) last day of the 9th month, enter 1/2 of line 14 (line 16 if amending) .............................
(
) last day of the 12th month, enter all of line 14 (line 16 if amending) ............................
Estimated Tax Payment Schedule
Computed
Prior period
Amount to be paid
Date
Installment (line 17)
Overpayment
(column b less column c)
(a)
(b)
(c)
(d)
1
2
3
4
Total
IA FRAN ES 2004
4
INSTALLMENT
F
Iowa Tax Payments for Financial Institutions
For Department of Revenue Use
FOR CALENDAR YEAR _____ OR FISCAL YEAR ENDING __________ , _____
Address Change
FEDERAL TIN
______________________________________________ s
PERIOD
s
07 ____________________________________________ s
CODE:
DAYTIME TELEPHONE #
AMOUNT OF PAYMENT $ _____________________________________ s
please use whole dollars
Mail to:
DATE PAYMENT MAILED: ___________________________________________________
Franchise Tax Return Processing
Iowa Department of Revenue
PO Box 10413
Make check or money order payable to: "Treasurer - State of Iowa"
43-006 (6/2/03)
Des Moines, IA 50306-0413
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