Form Rv - F1406301 - Franchise And Excise Tax Federal Income Revision Form
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1
2TENNESSEE DEPARTMENT OF REVENUE
FRANCHISE AND EXCISE TAX
Please submit to:
FEDERAL INCOME REVISION FORM
TN Department of Revenue
ATTN: F&E Unit
Taxpayer Name
P.O. Box 190644
Nashville, TN 37219-0644
FEIN
Account Number
Taxable Period Ending
As last reported
Net change
As amended
Increase (Decrease)
1.
Federal income or loss per Schedule J, Line 1
ADDITIONS
2.
Tennessee excise tax expense (to the extent reported for federal purposes)
3.
Contribution carryover from prior period(s)
4.
Capital gains offset by capital loss carryover or carryback
5.
Any depreciation permitted as a deduction in computing federal taxable
income solely as a result of the provision of the federal JCWA Act of 2002,
and any expense/depreciation deducted as a result of "safe harbor" lease
elections
6.
Other*________________________________________________
7.
Total additions - Add Lines 2 through 6
DEDUCTIONS
8.
Dividends received from subsidiaries, at least 80% owned
9.
Dividends received from corporations, at least 80% owned (Per PC 406
signed into law 6/17/99)
10. Current year contributions in excess of amount allowed by the federal
government
11. Portion of current year's capital loss not included in federal taxable income
12. Any income included for federal tax purposes and any depreciation or other
expense that could have been deducted for "safe harbor" lease elections
13. Depreciation under the provisions of IRC Section 168 prior to the
computation of depreciation under the federal JCWA Act of 2002, and any
excess gain or loss from the resulting basis adjustment
14. Other*______________________________________________
15. Total deductions - Add Lines 8 through 14
COMPUTATION OF TAXABLE INCOME
16. Total business income (loss) - Add Lines 1 and 7, less Line 15 (If loss,
complete Schedule K on Page 2)
%
%
%
17. Apportionment ratio (Schedule N, O, P, R, S, or SE, if applicable, or 100%)
18. Apportioned business income (loss) (Line 16 multiplied by Line 17)
19. Add: Non-business earnings directly allocated to TN (From Schedule M,
Line 9)
20. Deduct: Loss carryover from prior years
21. Income subject to excise tax (Add Lines 18 and Line 19, less Line 20)
22. Excise tax due (Line 21 X 6%, or 6.5% for returns ending on or after
7/15/02)
23. Less: Excise tax paid
24. Less: Tax credits
25. Additional excise tax due (overpaid) per federal income revisions (Line
22 less Lines 23 and 24)
*Explanation for an entry on this line must be shown on form or attached documentation
I, the undersigned, declare under the penalty of perjury, that I have examined this form, including all accompanying schedules and statements, and to
the best of my knowledge and belief, they are true, correct, and complete.
Power of Attorney
YES
Check Yes if this taxpayer’s signature certifies
Taxpayer’s signature
Date
Title
that this preparer has the authority to execute
this form on behalf of the taxpayer and is
Tax preparer’s signature
Date
Telephone
authorized to receive and inspect confidential
tax information and to perform any and all
Tax preparer’s address
City
State
Zip
acts relating to respective tax matters.
RV – F1406301
Page 1
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