Form Ft: 1-1in - Initial Foreign Corporation Franchise Tax Return, Permit Application, And Annual Report Page 2

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FT: 1-1IN

PAGE 2

Schedule A – LOCATION AND VALUE OF PROPERTY

Enter by county the assessed value of all real and personal property held by the corporation in the State of Alabama. This information is

required by Section 40-14-44

Code of Alabama 1975.

COUNTY

ASSESSED VALUE

COUNTY

ASSESSED VALUE

COUNTY

ASSESSED VALUE

1 Autauga

24 Dallas

47 Marion

2 Baldwin

25 Dekalb

48 Marshall

3 Barbour

26 Elmore

49 Mobile

4 Bibb

27 Escambia

50 Monroe

5 Blount

28 Etowah

51 Montgomery

6 Bullock

29 Fayette

52 Morgan

7 Butler

30 Franklin

53 Perry

8 Calhoun

31 Geneva

54 Pickens

9 Chambers

32 Greene

55 Pike

10 Cherokee

33 Hale

56 Randolph

11 Chilton

34 Henry

57 Russell

12 Choctaw

35 Houston

58 Shelby

13 Clarke

36 Jackson

59 St. Clair

14 Clay

37 Jefferson

60 Sumter

15 Cleburne

38 Lamar

61 Talladega

16 Coffee

39 Lauderdale

62 Tallapoosa

17 Colbert

40 Lawrence

63 Tuscaloosa

18 Conecuh

41 Lee

64 Walker

19 Coosa

42 Limestone

65 Washington

20 Covington

43 Lowndes

66 Wilcox

21 Crenshaw

44 Macon

67 Winston

22 Cullman

45 Madison

23 Dale

46 Marengo

TOTAL

Schedule B – SCHEDULE OF CAPITAL

This schedule is to be used to determine the total Alabama Capital employed at the date of qualification.

1 Alabama Cash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2 Alabama Accounts Receivable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3 Alabama Inventory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4 Alabama Tangible Property, exclusive of inventory, at book value . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5 Alabama Assets (either tangible or intangible) not included in lines 1 through 4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6 Total Alabama Capital (Sum of lines 1 through 5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DEDUCTIONS

7 Investment in securities issued by the state of Alabama or political subdivision thereof . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8 Mortgages receivable on Alabama real estate on which recording privilege tax has been paid . . . . . . . . . . . . . . . . . . . . . . . . . . .

9 Total deductions (sum of lines 7 and 8) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10 Alabama francise tax base (line 6 minus line 9) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11 Franchise tax due* (multiply line 10 by .003). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12 Permit fee paid (based on Alabama capital line 6) (see below for scale). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

COMPUTATION OF PERMIT FEE

The fee to be paid, based on Total Alabama Capital, (line 6) is as follows:

Less than $1,000.00 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 5.00

$1,000.00 and up to and including $10,000.00 . . . . . . . . . . . . . . . . . . . . . . $ 10.00

Over $10,000.00 and up to and including $25,000.00 . . . . . . . . . . . . . . . $ 20.00

Over $25,000.00 and up to and including $50,000.00 . . . . . . . . . . . . . . . $ 50.00

Over $50,000.00. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $100.00

11 EXECUTION AND VERIFICATION (Required by Sections 10-2B-1.20 and 40-14-44, Code of Alabama 1975)

I _________________________________________________ the ____________________________________________, do hereby swear (or affirm),

NAME OF OFFICER

TITLE OF OFFICER

depose, and say that the foregoing statement made to the Department of Revenue for the annual report and the collection of the franchise tax and permit fee

of said corporation, is true, full, and correct and also, if a professional corporation, that all the shareholders, at least one director and the president of said

corporation are qualified persons or otherwise legally authorized to practice the profession in the State of Alabama.

Date _____________________________________ ___________________________________________________ ___________________________

SIGNATURE OF OFFICER

TELEPHONE NUMBER

*Corporations that qualify to do business in the State of Alabama on or after July 1 of any year shall pay one half of the year’s franchise tax.