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2011

Corporation name

Franchise tax I.D.#

Tax year

FT 1120FI

Rev 5/10

Page 3

(3)

(1)

(2)

Factor

Weighted Factor

Weight

Schedule D-1 — Apportionment Ratio Summary

(carry to six decimals)

1. Sales (from Schedule D, line 17).............................................................

.70

2. Property (from Schedule D, line 21) ........................................................

.15

3. Payroll (from Schedule D, line 22)...........................................................

.15

4. Total apportionment ratio. Enter here and on Schedule A, line 2 ...............................................................................

If the denominator of any factor is zero, the weight given to the other factors must be proportionately increased so that the total weight

given to the combined factors used is 100%.

Schedule D-2 — Deposits Factor



The taxpayer is a “qualiﬁ ed institution” (as deﬁ ned on page 4) and, in lieu of using the property, payroll and sales factors, the taxpayer

hereby elects to apportion its net worth by using a single deposits fraction whose numerator is the deposits assigned to branches in

Ohio and whose denominator is the deposits assigned to branches everywhere.

Note: Qualiﬁ ed institutions that do not elect to use the deposits fraction and ﬁ nancial institutions that are not qualiﬁ ed institutions must

apportion net worth by using the property, payroll and sales factors and the weight accorded to each factor, as set forth above.

Ohio

Everywhere

Ratio

Deposits (if elected, enter ratio here and on Schedule A, line 2)

(carry to six decimals)

Schedule E – Net Value of Stock

Whole Dollars Only

1. Capital stock less treasury stock ............................................................................................................. 1.

DRAFT 4/29/10

2. Ownership interest of depositors ............................................................................................................. 2.

3. Retained earnings and additional paid-in capital..................................................................................... 3.

4. Reserves and net-deferred tax liability (except valuation reserves against speciﬁ c assets) ................... 4.

5. Total net worth (add lines 1 through 4) .................................................................................................... 5.

6. Exempted assets (from Schedule C, line 6) ............................................................................................ 6.

7. Net value of stock (line 5 minus line 6). Enter here and on Schedule A, line 1 or, if applicable, on

Schedule F, line 4 .................................................................................................................................... 7.

Schedule F – Adjusted Net Value of Stock for Holding Companies

Whole Dollars Only

1. Excludable investment (net of appreciation and goodwill) ...................................................................... 1.

2. Total assets (net of appreciation and goodwill) ...................................................................................... 2.

3. Ratio (divide line 1 by line 2) .................................................................................................................. 3.

4. Net value of stock (from Schedule E, line 7) .......................................................................................... 4.

5. Excludable portion (line 4 x line 3) ......................................................................................................... 5.

6. Adjusted net value of stock (line 4 minus line 5). Enter here and on Schedule A, line 1 ........................ 6.

Schedule G – Questionnaire (you must complete this schedule)

1. State or country where incorporated

2. Corporation tax records are in care of (name, please print)

3. Telephone number

E-mail address

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