Schedule K-1 (Form 60) - Shareholder'S Share Of North Dakota Income (Loss), Deductions, Adjustments, Credits, And Other Items - 2012

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North Dakota Office of State Tax Commissioner

Final

Amended

North Dakota

Schedule K-1

2012

Calendar year 2012

(Jan. 1 - Dec. 31, 2012)

Corporation's

tax year:

(Form 60)

Fiscal year:

Beginning _______________, 2012

Shareholder's Share of North Dakota Income (Loss),

Ending _______________, 20 ____

Deductions, Adjustments, Credits, and Other Items

Part 3 continued . . .

See separate instructions

9 Geothermal credit - after 12/31/08

Part 1

Corporation information

A Corporation's federal EIN

10 Employer internship program tax credit

11 Microbusiness tax credit

B Corporation's name, address, city, state, and ZIP code

12 Research expense tax credit

13 a Endowment fund tax credit

b Endowment fund contribution adjustment

14 Workforce recruitment credit

Shareholder information

Part 2

15 Credit for wages paid to mobilized employee

C Shareholder's SSN or FEIN (from Federal Schedule K-1)

16 a Angel fund investment credit

D Shareholder's name, address, city, state, and ZIP code

b Angel fund investment credit purchased

(from Federal Schedule K-1)

17 Housing incentive fund credit

Nonresident individual, estate or trust

Part 4

shareholder only - North Dakota income (loss)

E What type of entity is this shareholder? ____________________________

18 Corporation's apportionment factor

F If shareholder is an individual, estate, or trust, shareholder is a:

19 Ordinary income (loss)

Full-year resident

of North Dakota

Part-year resident

of North Dakota

20 Net rental real estate income (loss)

Full-year nonresident of North Dakota

21 Other net rental income (loss)

Yes

G Is shareholder included in a composite return?

22 Interest income

H Shareholder's stock ownership percentage: ____________%

23 Ordinary dividends

Part 3

All shareholders - North Dakota adjustments

24 Royalties

and tax credits

25 Net short-term capital gain (loss)

1 Interest from U.S. obligations

26 Net long-term capital gain (loss)

2 Renaissance zone income exemption

27 Net section 1231 gain (loss)

3 New or expanding business exemption

28 Other income (loss)

4 a Renaissance zone: Historic property

preservation/renovation tax credit

29 Section 179 deduction

b Renaissance zone: Renaissance fund

30 Other deductions

organization investment tax credit

31 I.R.C. Section 179 property disposition

gain (loss)

c Renaissance zone: Nonparticipating

property owner credit

Part 5

Nonresident individual shareholder only

5 Seed capital investment tax credit

32 North Dakota distributive share of income

6 Agricultural commodity processing

(loss)

facility investment tax credit

7 Supplier biodiesel or green diesel fuel tax credit

33 North Dakota income tax withheld

8 Seller biodiesel or green diesel fuel tax credit

34 North Dakota composite income tax

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