Form 64 - Bank Franchise Tax - 2004

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FORM 64
2004
Virginia Department of Taxation
BANK FRANCHISE TAX
Name of Bank or Trust Company
Federal I D Number
Each Bank and Trust Company
must file this return in duplicate
on or before March 1, 2004,
Street Address or PO Box
Date Chartered
with the Commissioner of
Revenue for the county or city in
which the principal office of the
City, Town or Post Office
State
ZIP Code
Bank or Trust Company is
located.
Each Bank and Trust Company must provide the Information specified below:
Principal Office is located in __________________________________, Virginia (Check Only One) 6 City 6 County 6 Town
IMPORTANT: Attach a copy of your Report of Condition and Income (Call Report) for December 31, 2003.
BANK CAPITAL ASSESSABLE AS OF JANUARY 1, 2004
CAPITAL ACCOUNTS
1. Total equity capital as shown on official report of condition and income (Attach a complete copy.)
1
ADDITIONS
2. Unallowable portions of valuation reserves:
a. Valuation reserve for losses on loans (From Schedule G, Line 4)
2a
b. Other (Attach schedule.)
2b
3. Total additions (Sum of Lines 2a and 2b)
3
§
4. Total (Sum of Lines 1 and 3)
4
DEDUCTIONS
§
5. Pro-rata share of United States obligations (From Schedule E, Line 5)
5
§
6. Retained earnings and surplus of subsidiaries included in gross capital (From Schedule F)
6
§
7. Deduction for goodwill (Attach schedule.)
7
§
8. Other (Attach schedule.)
8
9. Total deductions before apportionment (Sum of Lines 5 through 8)
9
COMPUTATION OF CAPITAL AND APPORTIONMENT
§
10. Capital before Virginia modifications (Line 4 less Line 9)
10
11. Apportionment percentage (Virginia core deposits divided by total core deposits. Attach computation.) Enter as a
%
§
percentage. NOTE: Apportionment percentage applies only to multistate banks, all other banks enter 100%
11
§
12. Capital attributable to Virginia. (Multiply Line 10 by the percentage on Line 11.)
12
§
13. Virginia real estate taxed by Virginia locality (From Schedule C, Total)
13
§
14. Tangible personal property otherwise taxed by Virginia locality (From Schedule D, Total)
14
COMPUTATION OF NET CAPITAL AND TAX
15. Net Taxable Capital (Line 12 less the total of Line 13 and Line 14)
15
§
16. Total Franchise Tax (See Tax Rate Schedule.)
16
17. Credit for Bank Franchise Tax due to localities (From Schedule H, Line 2)
17
18. Tentative State Bank Franchise Tax due (Line 16 less Line 17)
18
19. Less: Neighborhood Assistance Act Credit (Do not exceed the amount on Line 18.)
19
20. Less: Enterprise Zone Credit (From Form 301. Do not exceed the amount of Line 18 less Line 19.)
20
21. Less: Major Business Facility Job Credit
21
(From Form 304. Do not exceed the amount of Line 18 less the total of Line 19 and Line 20.)
22. Less: Historic Rehabilitation Credit (Do not exceed the amount of Line 18 less the total of Lines 19-21.)
22
23. Less: Employers of Disabled Individuals Credit (Do not exceed the amount of Line 18 less the total of Lines 19-22.)
23
24. Less: Worker Retraining Credit (Do not exceed the amount of Line 18 less the total of Lines 19-23.)
24
25. Less: Low Income Housing Credit (Do not exceed the amount of Line 18 less the total of Lines 19-24.)
25
26. STATE BANK FRANCHISE TAX DUE (Line 18 less the total of Lines 19 through 25.)
26
COMMISSIONER OF THE REVENUE’S
DECLARATION AND SIGNATURE
CERTIFICATE OF ASSESSMENT
I, the undersigned officer of the bank or trust company for which
I, the undersigned Commissioner of the Revenue for the County
this return is made, declare under the penalties provided by law
that this return has been examined by me and is, to the best of
(City) of
, Virginia, do hereby
my knowledge and belief, a true, correct, and complete return,
certify that I have this day assessed the bank or trust company
made in good faith, for the taxable year stated.
aforesaid with state bank franchise taxes for the tax year 2004,
as shown hereon.
Given under my hand this
day of
, 2004.
(Signature)
(Title of Officer)
(Commissioner of the Revenue)
(Phone Number)
(Date)

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