Form Pse - Extension Request For The Alabama Business Privilege Tax Return And Annual Report - 2002
ADVERTISEMENT
1A
D
R
LABAMA
EPARTMENT OF
EVENUE
Extension Request For The Alabama
2002
PSE
Business Privilege Tax Return and Annual Report
THIS FORM MUST BE SIGNED AND ALL SECTIONS MUST BE COMPLETED
Type of business entity (must check one):
For Balance Sheet Year:
Beginning
C Corporation
S Corporation
Other
______/______/________
Regular C Corporation
Regular S Corporation
Real Estate Investment Trust
(mm/dd/yyyy)
Insurance Company (See definitions)
Insurance Company (See definitions)
Limited Liability Entity
Ending
Financial Institution Group Member
Financial Institution Group Member
Business Trust
______/______/________
(mm/dd/yyyy)
LLE Taxed as Corporation
LLE Taxed as Corporation
Disregarded Entity
CY (Calendar Year)
LEGAL ENTITY NAME (PLEASE TYPE OR PRINT)
FY (Fiscal Year)
SY (Short Year)
MAILING ADDRESS
FEIN
RECEIVING STAMP
CITY, STATE, AND ZIP CODE
(This Space For Use By Alabama Department of Revenue)
FEDERAL BUSINESS CODE NUMBER (NAICS)
DOES THIS REPRESENT A CHANGE
Yes
OF ADDRESS?
1a County of incorporation or organization for all Alabama entities. . . .
1a
1b State or country of incorporation or organization . . . . . . . . . . . . . . .
1b
2a Date of qualification or registration in Alabama for foreign entities. .
2a
A
2b Date of incorporation or organization for all entities . . . . . . . . . . . . .
2b
T
(
)
2c Telephone number of the taxpayer . . . . . . . . . . . . . . . . . . . . . . . . . .
2c
T
A
3 Name of registered agent in Alabama. . . . . . . . . . . . . . . . . . . . . . . .
3
C
FEIN or social security number . . . . . . . . . . . . . . . . . . . . . . . . . . . .
H
Street address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
C
City, state and zip code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
H
E
4 Name of president or primary member/partner . . . . . . . (update
)
4
C
Social security number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
K
Street address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
H
City, state and zip code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
E
R
5 Name of secretary or secondary member/partner . . . . (update
)
5
E
Social security number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Street address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
City, state and zip code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6 Kind of business done in Alabama . . . . . . . . . . . . . . . . . . . . . . . . . .
6
7 Principal place of business in Alabama. . . . . . . . . . . . . . . . . . . . . . .
7
City, state and zip code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8 Kind of business done generally . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
9 Principal office and place of business if outside State of Alabama. .
9
City, state and zip code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
FOR DEPARTMENT USE ONLY
10
10 Secretary of State annual report fee $10 (corporations only) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
11 Privilege tax due* (minimum $100) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12 Payment due (sum of lines 10 and 11)
12
(Electronic Funds Transfer is not available for these taxes) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
*To avoid late payment penalties, 90% of the actual liability must be paid with this extension request.
I __________________________________________________________ the __________________________________________________________ , do hereby swear (or
NAME OF OFFICER, PRIMARY MEMBER, PARTNER, OR PAID PREPARER**
TITLE OF OFFICER, PRIMARY MEMBER, PARTNER, OR PAID PREPARER**
affirm), depose, and say, under penalties of perjury, that the information presented in this Annual Report and Extension Request is truthful and correct.
_________________________________ ____________________________________________________________________
DATE
SIGNATURE OF OFFICER, PRIMARY MEMBER, PARTNER, OR PAID PREPARER**
Make check payable to: Alabama Department of Revenue. Mail to: Alabama Department of Revenue, P.O. Box 327431, Montgomery, AL 36132-7431.
Telephone Number: (334) 353-7923.
**Paid Preparer must have power of attorney on file with the Department of Revenue or include one with this filing.
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