Form 355 - Business Or Manufacturing Corporation Excise Return - 2011
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9FOR PRIVACY ACT NOTICE,
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PRINT IN BLACK INK
SEE INSTRUCTIONS.
Form 355
Business or Manufacturing Corporation Excise Return
2011
Ovals must be filled in completely. Example:
If filing a calendar year return, leave blank. All others, enter appropriate dates below:
Tax year beginning (month–day–year)
Tax year ending (month–day–year)
FEDERAL IDENTIFICATION NUMBER (FID)
CORPORATION NAME
PRINCIPAL BUSINESS ADDRESS
CITY/TOWN/POST OFFICE
STATE
ZIP + 4
PRINCIPAL BUSINESS ADDRESS IN MASSACHUSETTS (IF DIFFERENT)
CITY/TOWN/POST OFFICE
STATE
ZIP + 4
1
Is the corporation incorporated within Massachusetts? . . . . . . . . . . . . . . . . . . . . . . 3
Yes
No
2
Type of corporation (select one, if applicable; enclose Form F-2). . . . . . . . . . . . . . . 3
Section 38 manufacturer
Mutual fund service
3
Type of corporation (select one, if applicable) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
R&D
Classified mfg
RIC
REIT
4
Did the corporation or predecessor file Form 3F in 2008? . . . . . . . . . . . . . . . . . . . . 3
Yes
No
5
Is the corporation filing a Massachusetts unitary return? (see instructions) . . . . . . 3
Yes
No
6
Is the corporation an insurance mutual holding corporation? . . . . . . . . . . . . . . . . . 3
Yes
No
7
Is the corporation requesting alternative apportionment (enclose Form AA-1)? . . . 3
Yes
No
8
Is this a final Massachusetts return? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Yes
No
9
Principal business code (from U.S. return) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 9
10
FID of principal reporting corporation if answer to line 5 is Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 10
11
Average number of employees in Massachusetts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
12
Average number of employees worldwide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
13
Date of charter in Massachusetts or first date of business in Massachusetts. . . . . . . . . . . . . . . . . . . . . . . . . . 13
14
Last year audited by IRS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 14
15
Have adjustments been reported to Massachusetts?
Yes
No
16
Is the corporation deducting intangible or interest expenses paid to a related entity? 3
Yes
No
17
Is the taxpayer enclosing a Taxpayer Disclosure Statement? 3
Yes
No
18
Is the taxpayer claiming exemption from the income measure of the excise pursuant to PL 86-272? 3
Yes
No
SIGN HERE. Under penalties of perjury, I declare that to the best of my knowledge and belief this return and enclosures are true, correct and complete.
Signature of appropriate officer (see instructions)
Date
Print paid preparer’s name
Preparer’s SSN
or PTIN
3
/
/
Title
Paid preparer’s phone
Paid preparer’s
(
)
EIN
Are you signing as an authorized delegate of the appropriate
Paid preparer’s signature
Date
Fill in if self-employed
corporate officer?
Yes (enclose Form M-2848)
No
/
/
Mail to: Massachusetts Department of Revenue, PO Box 7005, Boston, MA 02204.
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