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Form 355fc - Report Of Change To Federal Net Income - Massachusetts Department Of Revenue

Rev. 11/99

Massachusetts

Form 355FC

Department of

Report of Change to Federal Net Income

Revenue

For taxable year beginning

and ending

Registration

Name of corporation

Street address

City/Town

State

Zip

Federal Identification number (FID)

Return filed:

355A

355B

355C-A

355C-B

355S-A

355S-B

Other (specify) __________________

Form 355FC must be filed within 90 days of receipt of the Notice of Final Determination from the federal government.

Attach copy of said notice. Date of receipt _____________________________________

Submit a copy of the federal Revenue Agent’s Report and list in Schedules A and B below, in full detail, the changes to income as appearing in the federal Revenue Agent’s Report.

Schedule A.

Additional income and unallowable deductions.

Total A

Schedule B.

Nontaxable income and additional deductions.

Total B

Net adjustment (subtract total B from total A)

Net income originally reported to federal government . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Net adjustment as computed above . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Net income as corrected . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Any changes to the corporation’s Massachusetts excise must be computed on the back of this form. Any additional tax due must be paid with this report. Any abatement resulting

from the federal change may be claimed by completing the application for abatement on the back.

Declaration

Under penalties of perjury, I declare that I have examined this report, including accompanying schedules and statements, and to the best of my

knowledge and belief it is true, correct, and complete. If prepared by a person other than taxpayer, his/her declaration is based on all informa-

tion of which he/she has any knowledge.

Signature of officer

Date

Title

Individual or firm signature of preparer

Date

Address

Mail to: Massachusetts Department of Revenue, PO Box 7005, Boston MA 02204.