Form R-6950 - Schedule Ab - Louisiana Corporation Income Tax Add-Back Form

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R-6950 (1/17)
Schedule AB - Louisiana Corporation
Income Tax Add-Back Form
PLEASE PRINT OR TYPE
Related
Related
Related
Related
Recipient related member who received interest/intangi-
Member 1
Member 2
Member 3
Member 4
ble/management fee income from the taxpayer:
Recipient related member FEIN
1a
1a
Recipient related member name
1b
1b
Intangible expense amounts that resulted from
2
2
transactions with the recipient related member
Interest expense amounts that resulted from
3
3
transactions with the recipient related member
Management fee expense amounts that resulted from
4
4
transactions with the recipient related member
Total interest/intangible/management fee expenses
that resulted from transactions with related recipient
5
5
members (total lines 2, 3, and 4)
To determine the exempt amount of interest/intangible/management fee expense, complete the applicable section(s) below.
Exemption related to R.S. 47:287.82(A)(2) – LA tax
6
6
avoidance not a principal purpose of transaction(s)
Exemption related to R.S. 47:287.82(A)(3) – Paid,
7
7
accrued, or incurred to non-related person
Exemption related to R.S. 47:287.82(A)(1):
8
8
Jurisdiction(s) where recipient related member income
8a
8a
is “subject to tax”:
Enter the sum of Line 6 and Line 7
8b
8b
Subtract Line 8b from Line 5, enter the difference
8c
8c
Exempt amount apportioned to a taxing jurisdiction.
8d
8d
See instructions.
Exempt amount allocated\directly sourced to a taxing
8e
8e
jurisdiction. See instructions.
Enter the sum of Line 8d and Line 8e
8f
8f
Exempt Amount. Enter the sum of Lines 6, 7, and 8f
9
9
To qualify for the exemption provided in R.S.
Total interest/intangible/management fee expenses
47:287.82(A)(2), included in Line 6 of this form,
paid to all related members. (Sum all Line 5 for all
an informed authorized representative must sign
10
10
related members from all pages, and enter the amount
this form, certifying, under penalty of perjury, the
following: The transaction(s) giving rise to the
here and on Form CIFT-620, Schedule 2016F, Line 2b.
related member’s interest/intangible/management
fee expenses and costs, including both the direct
interest/intangible/management fee expense trans-
Total Exempt Amount. (Sum Line 9 for all related
action(s) between the taxpayer and the related
member(s) and any prior organizational restructuring
members from all pages, and enter the amount here
11
11
transaction(s) that facilitated such direct interest/
and on Form CIFT-620, Schedule 2016F, Line 3f.
intangible/management fee transaction(s), avoidance
of any Louisiana tax was not a principal purpose.
Name
Title
Signature
Date
(mm/dd/yyyy)
Attach additional pages as needed and enter the totals of Lines 5 and Lines 9 for all related members from all pages on Page 1, Line 10
and Line 11.

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