Form Ft 1120fi - Corporation Franchise Tax Report For Financial Institutions

Name

Franchise tax I.D. number

2005

(3)

(1)

(2)

Schedule D-1 — Apportionment Ratio Summary

Weighted Factor

Factor

Weight

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 “qualified institution” (as defined 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: Qualified institutions that do not elect to use the deposits fraction and financial institutions that are not qualified

institutions must apportion net worth by using the property, payroll and sales factors and the weight accorded to each

factor, as set forth above.

Ratio

Ohio

Everywhere

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

Schedule E – Net Value of Stock

Whole Dollars Only

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

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 specific 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 (line 1

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) __________________________________________________________________

(

)

3. Telephone number

E-mail address ________________________________________

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