Form Int-3 - Savings & Loan Association - Building & Loan Association Tax Return - 2007 Page 2
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1
2SCHEDULE A — TAXES CLAIMED AS CREDITS
DESCRIPTION (Do not list tangible personal property tax on leased property)
AMOUNT
TOTAL (Enter on Lines 7 and 17, Page 1)
$
AUTHORIZATION/NON-AUTHORIZATION
I authorize the Director of Revenue or his/her delegate to
I do NOT authorize the Director of Revenue or his/her delegate
PREPARER’S TELEPHONE
discuss my return and attachments with the preparer or any
to discuss my return and attachments with the preparer or any
member of his/her firm.
member of his/her firm.
SIGNATURE — PLEASE SIGN BELOW
, whose return is herewith submitted, declare that we have read and are familiar with
all of the statements contained in this return, including the accompanying schedules (if any) all of which are true and correct, according to
our best knowledge and belief, and that this return is a true and complete statement, in accordance with the law, for the taxable year
covered. I also declare under penalties of perjury that I employ no illegal or unauthorized aliens as defined under federal law and that I am
not eligible for any tax exemption, credit or abatement if I employ such aliens.
SIGNATURE OF OFFICER
DATE
PREPARER’S SIGNATURE (OTHER THAN TAXPAYER)
DATE
__ __ / __ __ / __ __ __ __
__ __ / __ __ / __ __ __ __
TITLE OF OFFICER
PHONE NUMBER
PREPARER’S ADDRESS AND ZIP CODE
FEIN OR PTIN
(_ _ _) _ _ _ - _ _ _ _
MAKE CHECK OR MONEY ORDER PAYABLE TO “FINANCIAL INSTITUTION TAX”. If you pay by check, you authorize the Department of Revenue to process the
check electronically. Any check returned unpaid may be presented again electronically. MAIL COMPLETED FORM AND ATTACHMENTS TO THE TAXATION
BUREAU, P.O. BOX 898, JEFFERSON CITY, MO 65105-0898.
MO 860-1135 (10-2007)
DOR-INT-3 (11-2006)
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