Form 109 - California Exempt Organization Business Income Tax Return - 2012
ADVERTISEMENT
1
2
3
4
5California Exempt Organization
TAXABLE YEAR
FORM
2012
109
Business Income Tax Return
Calendar Year 2012 or fiscal year beginning month _______ day _______ year ______, and ending month _______ day _______ year ______ .
Corporation/Organization Name
California corporation number
Address (suite, room, or PMB no.)
FEIN
-
City
State
ZIP Code
H Is the organization a non-exempt charitable trust as described
A First Return Filed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
in IRC Section 4947(a)(1)? . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
B Is this an education IRA within the meaning of
I Is this organization claiming any Enterprise Zone (EZ), Los Angeles
R&TC Section 23712? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
Revitalization Zone (LARZ), Local Agency Military Base Recovery Area
C Is the organization under audit by the IRS or has the IRS audited
(LAMBRA), Targeted Tax Area (TTA), or Manufacturing Enhancement
in a prior year? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
Area (MEA) tax benefits? . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
D Final Return?
Dissolved
Surrendered (Withdrawn)
J Is this organization a qualified pension, profit-sharing, or stock
Merged/Reorganized (attach explanation)
bonus plan as described in IRC Section 401(a)? . . . . . . .
Yes
No
Enter date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
_____________
K Unrelated Business Activity (UBA) Code . . .
E Amended Return . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
L Is this a Hospital? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
F Accounting Method Used: (1)
Cash (2)
Accrual (3)
Other
If “Yes,” attach IRS Schedule H (Form 990)
G Nature of trade or business _____________________________________
1 Unrelated business taxable income from Side 2, Part II, line 30 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
00
Taxable
2 Multiply line 1 by the average apportionment percentage ________% from the Schedule R,
Corpora-
tion
Apportionment Formula Worksheet, Part A, line 6 or Part B, line 2. See instructions . . . . . . . . . . . . . . . . . .
2
00
3 Enter the lesser amount from line 1 or line 2. If the unrelated business activity is wholly in California
and Schedule R was not completed, enter the amount from line 1. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
00
Taxable
4 Unrelated business taxable income from Side 2, Part II, line 30 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
00
Trust
5 Unrelated business taxable income from line 3 or line 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
00
6 Enterprise zone, LAMBRA, LARZ, TTA, or Pierce’s disease losses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
00
7 Net Operating Loss deduction. See General Information N . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
00
8 Add line 6 and line 7. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
00
Tax
9 Net unrelated business taxable income. Subtract line 8 from line 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
00
Computa-
10 Tax ________% x line 9. See General Information J . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
00
tion
11 a New jobs credit, amount generated. . . . . .
a) ____________ . . . . . 11 b) Amount claimed . . . . . . .
11b
00
c Tax credits from Schedule B. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11c
00
d Total Credits. Add line 11b and 11c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11d
00
12 Balance. Subtract line 11d from line 10. If line 11d is greater than line 10, enter -0-. . . . . . . . . . . . . . . . . . .
12
00
Total
13 Alternative minimum tax. See General Information O. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
00
Tax
14 Total tax. Add line 12 and line 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
00
15 Overpayment from a prior year allowed as a credit . . . . . . . . . . . . . .
15
00
16 2012 estimated tax payments. See instructions. . . . . . . . . . . . . . . . .
16
00
Payments
17 2012 withholding (Form 592-B and/or 593.) See instructions . . . . . .
17
00
18 Amount paid with extension (form FTB 3539) . . . . . . . . . . . . . . . . . .
18
00
19 Total payments and credits. Add line 15 through line 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
19
00
20 Tax due. Subtract line 19 from line 14. Pay entire amount with return. See instructions . . . . . . . . . . . . . . . .
20
00
21 Overpayment. Subtract line 14 from line 19. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21
00
22 Enter amount of line 21 to be applied to 2013 estimated tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
00
23 Use tax. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
23
00
Refund
(Direct
24 Refund. If the sum of line 22 and line 23 is less than line 21, then subtract the total from line 21 . . . . . . . .
24
00
Deposit of
Refund) or
a Fill in the account information to have the refund directly deposited. Routing number . . . . . . . .
24a
Amount
Due
b Type: Checking
Savings
c Account Number . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24c
25 Penalties and interest. See General Information M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
25
00
26
Check if estimate penalty computed using Exception B or C and attach form FTB 5806.
27 Total amount due. Add line 20, line 22, line 23, and line 25, then subtract line 21 from the result . . . . . . . . . . 27
00
Form 109
2012 Side 1
3641123
C1
For Privacy Notice, get form FTB 1131.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial