Form 1120f - Franchise Return For Financial Institutions

I OWA

Iowa 1120F 1999

d e p a r t m e n t o f R eve n u e a n d F i n a n c e

Franchise Return For Financial Institutions

Period Ending ____/____ (mm/yy)

OFFICIAL USE ONLY

Check all that apply:

This is a Shor t Period Return.

Mailing Address Change

The bank has opened, closed, or moved branch locations.

(Provide a schedule.)

Contact Person

Phone No.: ( ______ ) ______-________

Name and Address

01 Pay Return

02 Amended Pay

03 No Pay Return

04 Amended No Pay

Please check the appropriate box.

Federal TIN: _________________________

Is this a first or final return?

If yes, check the appropriate boxes.

First Return:

New Business

Successor

Entering Iowa

Filing Status:

Separate Iowa/Federal S Corporation

Final Return:

Reorganized

Merged

Dissolved

Separate Iowa/Separate Federal

Separate Iowa/Consolidated Federal

Name of Consolidated Parent: ____________________________

Type of Return:

Parent’s Federal TIN: ____________________________________

100% Iowa

Not 100% Iowa

Was Federal income or Federal tax changed for any prior period(s)?

No Iowa banking locations

Inactive bank

Yes. Periods Changed: __________________ Reason:

Federal audit

USE WHOLE DOLLARS ONLY

1120X

1139

N o

1. NET INCOME. From Federal Return (before net operating loss) ................................................................. 1 . ____________________ .00

2. INTEREST and DIVIDENDS Exempt from Federal income tax ............................................................ 2. _____________________ .00

3. IOWA FRANCHISE TAX EXPENSED ON FEDERAL RETURN ............................................................. 3. _____________________ .00

4. OTHER ADDITIONS (from Schedule A) ................................................................................................. 4. _____________________ .00

5. TOTAL IOWA INCOME (add lines 1 through line 4) .............................................................................................. 5. ____________________ .00

6. OTHER REDUCTIONS (from Schedule D) ............................................................................................. 6. _____________________ .00

7. INCOME SUBJECT TO APPORTIONMENT (line 5 minus line 6) ........................................................ 7. _____________________ .00

8. IOWA PERCENTAGE (from Schedule 59F, line 19) ............................................................................... 8. _____________________ %

9. DEDUCTION for APPORTIONED INCOME (from Schedule 59F, line 22) .......................................... 9. _____________________ .00

10. NET OPERATING LOSS (from Schedule F) ......................................................................................... 10. _____________________ .00

11. TOTAL REDUCTIONS (line 6 + line 9 + line 10) .................................................................................................. 11. ____________________ .00

12. IOWA NET INCOME subject to Franchise Tax (line 5 minus line 11) ............................................................... 12. ____________________ .00

13. COMPUTED TAX (line 12 times 5%) .................................................................................................................... 13. ____________________ .00

14. MINIMUM TAX (from IA4626F) .............................................................................................................................. 14. ____________________ .00

15. TOTAL TAX (line 13 plus line 14) .......................................................................................................................... 15. ____________________ .00

16. MINIMUM TAX CARRYFORWARD CREDIT (from IA 8827F) ............................................................. 16. _____________________ .00

17. PAYMENTS (from Schedule C2, line 9) ................................................................................................. 17. _____________________ .00

18. TOTAL CREDITS and PAYMENTS (line 16 plus line 17) .................................................................................... 18. ____________________ .00

19. NET AMOUNT (line 15 minus line 18) .................................................................................................................. 19. ____________________ .00

20. PENALTY IA2220 (attach IA2220) .......................................................................................................... 20. _____________________ .00

21. PENALTY (failure to pay or failure to file) ............................................................................................. 21. _____________________ .00

22. TOTAL PENALTIES (line 20 plus line 21) ............................................................................................................. 22. ____________________ .00

23. INTEREST .............................................................................................................................................................. 23. ____________________ .00

24. TOTAL DUE (line 19 + line 22 + line 23) Make check payable to “Treasurer - State of Iowa” .................... 24. ____________________ .00

25. NET OVERPAYMENT (line 19 minus line 20) ..................................................................................................... 25. ____________________ .00

26. CREDIT TO NEXT PERIOD'S ESTIMATED TAX ................................................................................. 26. _____________________ .00

27. REFUND REQUESTED (line 25 minus line 26) ................................................................................................. 27. ____________________ .00

28.

28. ____________________

FOR OFFICIAL USE ONLY

29.

29. ____________________

A complete copy of your Federal return, as filed with the Internal Revenue Service, MUST be filed with this return. If no copy is attached, this

WILL NOT be considered a complete return.

Under penalties of perjury, I declare that I have examined this return, any attached schedules/statements, and to the best of my knowledge,

believe it to be true, correct and complete. If prepared by a person other than the taxpayer, the declaration is based on all information of which

there is any knowledge.

Officer's Signature ___________________________________ Date _________________ Title ________________________________

Preparer's Signature __________________________________ Date _________________ Preparer's ID No. _____________________