Form Rv-F1320501 - Franchise And Excise Tax Exempt Entity - Disclosure Of Activity

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Franchise and Excise Tax Exempt Entity
Disclosure of Activity
EXEMPTION PERIOD
TAXPAYER NAME
EXEMPT ACCOUNT NO.
Organizational Structure
(a) Member/Partner Name
(b) Ownership Percentage
(c) Relationship
1.
2.
3.
4.
Part I
Family-Owned Non-Corporate Entity (“FONCE”)
(a) Passive Investment Income
Source of Income
Gross Receipts
Source of Income
Gross Receipts
Royalties
Gain on sale/exchange of stock
Dividends
Gain on sale/exchange of securities
Annuities
Rent from residential property
Interest
Rent/income from farming
(b) Non-Passive Income
Source of Income
Gross Receipts
Industrial & Commercial Real Estate Rental
Other (please describe):
Total Non-Passive Income
$
Part II
Farming Activity
(a) Type of Income
(b) Assets valued at original cost to entity
Farm Income
$
Assets used in farming
$
Other Income
$
Other assets
$
Total Income
$
Total assets
$
Part III
Holding a Personal Residence
(a) Description of Property
(b) Property Address
(c) Resident(s) / Number of days residing at
property during the exemption period
Contact Person:
Title:
Phone Number:
Email address:
Attach additional schedules as needed.
RV-F1320501
INTERNET (8-12)

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