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Form 480.30(II) Rev. 05.02

Incentives - Page 4

Part VIII

Questionnaire

identification number, (b) percentage owned, and (c) taxable

Yes

Did the exempt business file an option under Section 936 of the

income (or loss) before net operating loss and special deductions

Federal Internal Revenue Code? ................................................

of the corporation for the taxable year (even when such taxable

(1)

Did the exempt business keep any part of its records on a

year does not coincide with the one of the corp. or part. for

computerized system during this year? .....................................

which this return is filed).

(2)

The exempt business books are in care of:

Is the corporation a subsidiary in an affiliated group or a parent

13.

Name ______________________________________________

subsidiary of a controlled group?...................................................

(13)

Address ___________________________________________

If “Yes”, enter the employer's identification number and the name

__________________________________________________

of the parent corporation: ______________________________

Check accounting method used:

___________________________________________________

Cash

Accrual

Did any individual, partnership, corporation, estate or trust at the

14.

Other (specify): ____________________________

end of the taxable year own, directly or indirectly, 50% or more

Did the exempt business file the following documents?

of the corporation's voting stocks? If “Yes”, attach a schedule

(14)

Informative Return (Forms 480.5, 480.6A, 480.6B) .............

showing the name and employer's identification number (Do not

(a)

(5a)

Withholding Statement (Form 499R-2/W-2PR) ......................

include any information entered in question 13). Enter the

(5b)

(b)

If your gross income exceeds $1,000,000 and is a foreign

percentage owned:

corporation, did you submit financial statements audited by a

Enter the amount of exempt interest: _____________________

15.

CPA licensed in Puerto Rico?......................................................

Does the exempt business have other exempt activities not

(6)

16.

Number of employees during the year: ___________________

covered under the Industrial Incentives Acts? (Attach

(16)

Production:__________ (b) Non-production:____________

schedule) Under which Act ? __________________________

(a)

Did the exempt business claim a deduction for expenses

Have you made a timely election under:

(17)

17.

connected with:

; Section 3(f) Act No. 8 of 1987

;

Section 5(b) Act No. 52 of 1983

Vessels? ............................................................................

;

; Section 6(f) Act No. 135 of 1997

(a)

(8a)

Section 3(a)(i)(D) Act No. 78 of 199 3

Living expenses? ...............................................................

Enter the total amount of charitable contributions to

(8b)

(b)

18.

Employees attending conventions or meetings outside

municipalities claimed during the taxable year: ______________

(c)

Puerto Rico or the United States? ........................................

Indicate if your books reflect premiums paid by unauthorized

(8c)

19.

Have you been audited by the IRS?...........................................

insurers .......................................................................................

(9)

(19)

Which years?_______________________________________

Indicate the method used to allocate expenses:

20.

Did the exempt business distribute dividends other than stock

Profit - Split

Cost Sharing

Others __________

10.

dividends or distributions in liquidation in excess of the

If a single method is used, Profit Split or Cost Sharing, indicate

21.

current and accumulated earnings during this year?................

the following:

(10)

Is the exempt business a partner in a special partnership?......

Profit - Split Intangible Income

Cost Sharing Payment

(11)

11.

Name _____________________________________________

Indicate the method used to claim the credit in the Federal

22.

Employer's identification number ________________________

Corporation Income Tax Return:

Did the corporation at the end of the taxable year own, directly

Economic Activity Limitation

12.

or indirectly, 50% or more of the voting stocks of a corporation

Percentage Credit Limitation

who is engaged in trade or business in Puerto Rico? ...............

Employer number assigned by the Department of Labor and

(12)

23.

If “Yes”, attach a schedule showing: (a) name and employer's

Human Resources __________________________________

OATH

We, the undersigned, president (or vice president or other principal officer) and treasurer (or assistant treasurer) or agent of the exempt business for which this income tax

return is made, each for himself, declare under the penalty of perjury that this return (including schedules and statements attached) has been examined by us and is, to the

best of our knowledge and belief, a true, correct, and complete return, made in good faith, pursuant to the Puerto Rico Internal Revenue Code of 1994, as amended, and the

Regulations thereunder.

_______________________________________________

President's or vice president's signature

Treasurer's or assistant treasurer's signature

___________________________________________________

Agent

Affidavit no. _______________________

Sworn and subscribed before me by _________________________________________ , of legal age, ____________________________ [civil status],

NOTARY

______________________ [occupation], and resident of ________________ , ______ , and by ____________________________________________,

SEAL

of legal age, ______________ [civil status], _________________________ [occupation], and resident of ______________________, ______________,

personally known to me or identified by means of ________________________________________, at __________________, ____________________,

this ___th day of _________________, ___.

_____________________________________________________________

_________________________________________________

Title of the person administering oath

Signature of the person administering oath

Specialist's Use Only

I declare under the penalty of perjury that this return (including schedules and statements attached) has been examined by me and to the best of my knowledge and belief is a true,

correct and complete return. The declaration of the person who prepares this return is with respect to the information received, and this information may be verified.

Specialist's name (Print letter)

Date

Specialist's social security number

Registration number

Check if

self-employed

Firm's name

Employer's identification number

Specialist's signature

Address

Zip code

Conservation Period: Ten (10) years