Form 6y - Wisconsin Modification For Dividends - 2015
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2015 Form 6Y - Wisconsin Modification for Dividends
Designated Agent Name
Federal Employer ID Number
Corporation Name:
Combined
FEIN:
Totals
Name of Payer Corporation
1a
Payee's Ownership of Payer (check (√) one)
Date Acquired by Payee
> 70%
> 50% but < or = 70%
M M
D
D
Y
Y
Y
Y
.00
.00
.00
.00
1a
1a
Name of Payer Corporation
1b
Payee's Ownership of Payer (check (√) one)
Date Acquired by Payee
> 70%
> 50% but < or = 70%
.00
.00
.00
.00
M M
D
D
Y
Y
Y
Y
1b
1b
Name of Payer Corporation
1c
Payee's Ownership of Payer (check (√) one)
Date Acquired by Payee
> 70%
> 50% but < or = 70%
M M
D
D
Y
Y
Y
Y
.00
.00
.00
.00
1c
1c
Name of Payer Corporation
1d
Payee's Ownership of Payer (check (√) one)
Date Acquired by Payee
> 70%
> 50% but < or = 70%
M M
D
D
Y
Y
Y
Y
1d
.00
.00
.00
.00
1d
Name of Payer Corporation
1e
Payee's Ownership of Payer (check (√) one)
Date Acquired by Payee
> 70%
> 50% but < or = 70%
M M
D
D
Y
Y
Y
Y
.00
.00
.00
1e
.00
1e
Name of Payer Corporation
1f
Payee's Ownership of Payer (check (√) one)
Date Acquired by Payee
> 70%
> 50% but < or = 70%
M M
D
D
Y
Y
Y
Y
.00
1f
.00
.00
.00
1f
.00
.00
.00
1g
.00
1g Add lines 1a through 1f . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1g
1h Total of line 1g from additional Forms 6Y (see instructions) . . . . . 1h
.00
.00
.00
1h
.00
2
2
Add lines 1g and 1h . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
.00
.00
.00
.00
3
3
Enter foreign taxes paid on dividends included on line 2 . . . . . . . 3
.00
.00
.00
.00
4
Subtract line 3 from line 2 . Enter this amount on Form 6, Part II,
.00
.00
.00
.00
line 4a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
4
IC-425
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