Form Inc 250 - Individual Income Tax Return

TENNESSEE DEPARTMENT OF REVENUE

INDIVIDUAL INCOME TAX RETURN

ACCOUNT NUMBER

YOUR SSN:

INC

250

SPOUSE'S SSN:

FEIN:

Please provide the county and city (if within an incorporated municipality) of the taxpayer's legal residence

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on the lines below.

County _____________________________________________________________

City _______________________________________________________________

AFFIDAVIT FOR EXEMPTION

CHECK ALL BOXES WHICH APPLY:

TAX COMPUTATION

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If filed late, compute penalty at 5% of the tax (Line 4 minus Line 5) for each 1 to 30 DAY

PERIOD for which TAX IS DELINQUENT (Total penalty NOT TO EXCEED 25%.) Minimum

penalty is $15 regardless of the amount of tax due or whether there is any tax due

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If filed late, compute interest at 11.00% per annum on the tax (Line

4 minus Line 5) from the due date of payment to the date paid

FOR OFFICE

USE ONLY

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Parent category: Financial