California Form 568 - Limited Liability Company Return Of Income - 2004
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TAXABLE YEAR
CALIFORNIA FORM
2004
Limited Liability Company Return of Income
568
For calendar year 2004 or fiscal year beginning month ________ day _______ year 2004, and ending month ________ day ________ year ________ .
A Principal business activity name
Limited liability company name (type or print)
D Secretary of State file number
(same as federal)
b
E Date business started in California
DBA
B Principal product or service
b
(same as federal)
F Enter total assets at end of year.
Number and street (or PO Box number if mail is not delivered to street address)
PMB no.
See instructions.
C Principal business activity code
City
State
ZIP Code
b $
(same as federal)
I Check applicable box
b
(1)
Initial return
H FEIN
b (2)
G Check accounting method:
Final
(3)
Amended
b (1)
b
return
return
Cash
(2)
Accrual
(3)
Other (attach explanation)
J J J J J Enter the maximum number of members in the LLC at any time during the
T T T T T Is this LLC a publicly traded partnership as defined in
year. Attach a California Schedule K-1 (568) for each of these members . . . . b
IRC Section 469(k)(2)? . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes No
K K K K K Is this LLC an investment partnership? See General Information O . . . . . . . . b
Yes No
U U U U U (1) Is this LLC a business entity disregarded for tax
L L L L L Is this LLC apportioning income to California using Schedule R? . . . . . . . . . b
purposes? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes No
Yes No
M M M M M Was there a distribution of property or a transfer (for example,
(2) If “Yes,” see instructions and complete Side 1 and
by sale or death) of an LLC interest during the taxable year? . . . . . . . . . . . . . b
Side 3. Are there credits or credit carryovers
Yes No
attributable to the disregarded entity? . . . . . . . . . . . . b
O O O O O Did this LLC or its subsidiary(ies) have a transfer or acquisition
Yes No
of more than 50% in control or ownership? (See Instructions – Penalties May
V V V V V Has the limited liability company included a Reportable
Apply.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b
Transaction, Listed Transaction, or Registered Tax Shelter
Yes No
P P P P P (1) Does the LLC have any foreign nonresident members? . . . . . . . . . . . . . b
within this return? (See Instructions for definitions). If
Yes No
(2) Does the LLC have any nonresident members? . . . . . . . . . . . . . . . . . . . b
“Yes,” complete and attach federal Form 8886 or 8271
Yes No
(3) Were Form 592, Form 592-A, and Form 592-B filed for these members? b
for each such transaction . . . . . . . . . . . . . . . . . . . . . . . . . b
Yes No
Yes No
Q Q Q Q Q Are any members in this LLC also LLCs or partnerships? . . . . . . . . . . . . . . . . .
Yes No
S S S S S Is this LLC a member or partner in another LLC or partnership? . . . . . . . . . . .
Yes No
1 Total income from Limited Liability Company Income Worksheet. See instructions . . . . . . . . . . . . . . . . . . . b
1
2 Limited Liability Company fee. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b
2
3 2004 annual Limited Liability Company tax. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b
3
Enclose,
4 Nonconsenting nonresident members’ tax liability from Schedule T (Side 2) . . . . . . . . . . . . . . . . . . . . . . . . .
4
but do
5 Total tax and fee. Add line 2, line 3, and line 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
not
6 Amount paid with form FTB 3537 and 2004 form FTB 3522 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
staple,
any
7 Overpayment from prior year allowed as a credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
payment.
8 Nonresident Withholding Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
9 Total payments. Add line 6, line 7, and line 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
10 Tax and fee due. If line 5 is more than line 9, subtract line 9 from line 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
11 Overpayment. If line 9 is more than line 5, subtract line 5 from line 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
12 Amount of line 11 to be credited to 2005 tax or fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
13 Use Tax. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b
00
13
. . . . .
, , , , ,
14 Refund. If the total of line 12 and line 13 is less than line 11; subtract the total from line 11 . . . . . . . . .
14
15 Penalties and interest. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
. . . . .
, , , , ,
16 Total amount due. Add line 10, line 12, line 13, and line 15, then subtract line 11 from the result . . . . . . . 16
Federal TIN/SSN b
Single Member LLC Information and Consent — Complete only if the LLC is disregarded.
Sole Owner’s name (as shown on owner’s return)
SOS File No.
Return filed with the FTB by the Ownerb
Street Address, City, State, and ZIP Code
(1) Form 540
(5) Form 541
Member’s Consent Statement: I consent to the jurisdiction of the State of California to tax my LLC income and agree to file returns and pay tax as may be
(2) Form 100
(6) Form 100S
required by the Franchise Tax Board.
(3) Form 565
(7) Form 568
Signature
Date
Title
(4) Other _________________
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is
Please
true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Sign
Telephone
Here
b
(
)
Signature of officer
Date
Paid preparer’s SSN/PTIN
Date
Paid
Check if
preparer’s
self-employed
b
Paid
signature
Preparer’s
FEIN
-
Use Only
Firm’s name (or yours,
b
if self-employed)
Telephone
and address
b
(
)
Form 568 C1 2004 Side 1
56804103
For Privacy Act Notice, get form FTB 1131.
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