Form Ft 1-1a - Application For Tax Extension Request, Permit Application, And Annual Report (1999)
ADVERTISEMENT
1
2A
D
R
LABAMA
EPARTMENT OF
EVENUE
FT: 1-1A
8/98
1999
Application For Tax Extension Request,
Permit Application, and Annual Report
If a completed Franchise Tax Return cannot be timely filed, a completed Application For Extension Request, Permit Application and
Annual Report must be filed with the Alabama Department of Revenue, Corporate Tax Division, on or before March 15, 1999.
RECEIVING STAMP
LEGAL CORPORATION NAME (PLEASE TYPE OR PRINT)
MAILING ADDRESS
EXTENSION CODE
CITY, STATE, AND ZIP CODE
(This Space For Use By Alabama Department of Revenue)
ALABAMA FRANCHISE
TAX ACCOUNT NO.
FEDERAL EMPLOYER IDENTIFICATION NUMBER (FEIN)
FEDERAL STANDARD INDUSTRIAL CLASSIFICATION CODE
PLEASE INCLUDE SOCIAL SECURITY NUMBERS FOR ALL CORPORATE
OFFICERS
1 State or country of incorporation . . . . . . . . . . . . . . . . . . . . . . . . .
1
2 Date of Qualification in Alabama. . . . . . . . . . . . . . . . . . . . . . . . .
2
3 Name of registered agent in Alabama. . . . . . . . . . . . . . . . . . . .
3
FEIN or Social Security No. of registered agent . . . . . . . . . .
Street address of registered office in Alabama . . . . . . . . . . .
City, State and Zip Code. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4 Name of president of corporation . . . . . . . . . . . . . . . . . . . . . . . .
4
Social Security Number. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Street Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
City, State and Zip Code. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5 Name of secretary of corporation. . . . . . . . . . . . . . . . . . . . . . . . .
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
City, State and Zip Code. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8 Kind of business done generally. . . . . . . . . . . . . . . . . . . . . . . . . .
8
9 Principal office and place of business in state or
9
country of incorporation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10 Date of incorporation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
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 his profession in the State of Alabama.
Date _____________________________________ ___________________________________________________ ___________________________
SIGNATURE OF OFFICER
TELEPHONE NUMBER
12 Secretary of State Annual Report Fee
DEPARTMENT USE ONLY
12
$10.00
SSAR
(Prior year’s credit cannot be used to pay this fee) . . . . . . .
13 1999 Permit Fee (minimum $5.00) (See page 2)
13
(Prior year’s credit cannot be used to pay this fee) . . . . . . .
TPR
14 1999 Franchise Tax (minimum $25.00)
14
(At least 80% of the 1999 Franchise Tax). . . . . . . . . . . . . . . . . .
15 Less prior year’s Franchise Tax credit
15
TFR
(Attach Letter of Credit, if available) . . . . . . . . . . . . . . . . . . . . .
16 1999 Franchise Tax due
16
(Line 14 minus Line 15) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
TAR
17 Total amount due
17
(Add Lines 12, 13 and 16) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Make check payable to:
Mail to: Alabama Department of Revenue, Foreign Franchise Tax Section,
CHECK THIS BOX IF PAYMENT
MADE THROUGH ELECTRONIC
Alabama Department of Revenue
P. O. Box 327330, Montgomery, AL 36132-7330
FUNDS TRANSFER (EFT)
(334) 242-9807
(See EFT Instructions Page 2)
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