Form Bca-1.35 - Allocation Factor Interrogatories - 2003 Page 2
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1
2PART II: COMPUTATION OF BUSINESS TRANSACTED
(Gross receipts — see notes on page 4)
Line
Line
(C)
(d)
The information below
reference
reference
Gross amount
Gross amount
is given as of
to
to
of business
of business
________________ , _______
IRS Form
IRS Form
transacted
transacted
(Month & Day)
(Year)
everywhere
at or from
1120
1120S
Illinois
Gross receipts, less returns
1c
1c
$ _______________
$ _______________
Dividends
4
4b (Sch. K)
$ _______________
$ _______________
Interest
5
4a (Sch. K)
$ _______________
$ _______________
Gross rents
6
3a (Sch. K)
and Line 2
(form 8825)
$ _______________
$ _______________
Gross royalties
7
4c (Sch. K)
$ _______________
$ _______________
Capital gains-
Sch. D
Sch. D
gross sales price
[Line 1
[Line 1
col. (d)]
col. (d)]
$ _______________
$ _______________
Sales of business
Form 4797
Form 4797
property - gross
[Line 2
[Line 2
sales price
col (d) and
col. (d) and
Line 20]
Line 20]
$ _______________
$ _______________
Other income
10
5
$ _______________
$ _______________
Non-taxable receipts:
Tax-exempt interest
Sch. M-1
Sch. M-1
or dividends
Line 7
Line 5a
$ _______________
$ _______________
Other
$ _______________
$ _______________
TOTAL GROSS RECEIPTS
$ ____________
$ ____________
(Gross Amount of Business Transacted)
IMPORTANT!
These interrogatories must be accompanied by a photocopy of the appropriate pages of the IRS Form 1120 or 1120S
containing the line references for all lines completed above. If the corporation is included in a consolidated return, the
appropriate schedules must also be provided.
The undersigned corporation has caused this statement to be signed by a duly authorized officer who affirms, under
penalties of perjury, that the facts stated herein are true.
Dated _______________________________ , _________
___________________________________________
(Month & Day)
(Year)
(Exact Name of Corporation)
_________________________________________
(Any Authorized Officer's Signature)
_________________________________________
(Type or Print Name and Title)
Page 2
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