Form 1120-Pol - U.s. Income Tax Return For Certain Political Organizations - 2012

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1120-POL
U.S. Income Tax Return for Certain Political Organizations
OMB No. 1545-0129
Form
2012
Department of the Treasury
Internal Revenue Service
, 20
For calendar year 2012 or other tax year beginning
, 2012, and ending
Check the box if this is a section 501(c) organization .
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Employer identification number
Name of organization
Check if:
Final return
Number, street, and room or suite no. (If a P.O. box, see instructions.)
Candidates for U.S. Congress Only
Name change
If this is a principal campaign committee, and it is the
Address change
ONLY political committee, check here .
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City or town, state, and ZIP code
If this is a principal campaign committee, but is NOT
Amended return
the only political committee, check here and attach a
copy of designation (see instructions.)
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1
1
Dividends (attach statement) .
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Interest
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Gross rents .
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3
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Gross royalties .
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4
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Capital gain net income (attach Schedule D (Form 1120)) .
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Net gain or (loss) from Form 4797, Part II, line 17 (attach Form 4797)
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6
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Other income and nonexempt function expenditures (see instructions) .
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7
8
Total income. Add lines 1 through 7
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Salaries and wages .
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Repairs and maintenance .
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10
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11
Rents .
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12
Taxes and licenses .
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12
13
Interest
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Depreciation (attach Form 4562) .
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14
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Other deductions (attach statement)
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16
Total deductions. Add lines 9 through 15
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16
17
Taxable income before specific deduction of $100 (see instructions). Section 501(c) organizations show:
a
Amount of net investment income .
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b
Aggregate amount expended for an exempt function (attach statement)
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17c
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Specific deduction of $100 (not allowed for newsletter funds defined under section 527(g))
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18
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Taxable income. Subtract line 18 from line 17c. (If line 19 is zero or less, see the instructions.) .
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Income tax. (see instructions)
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20
21
Tax credits. (Attach the applicable credit forms.) (see instructions) .
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21
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Total tax. Subtract line 21 from line 20 .
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22
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Payments: a
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Tax deposited with Form 7004
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b
Credit for tax paid on undistributed capital gains (attach Form 2439)
23b
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Credit for federal tax on fuels (attach Form 4136) .
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23c
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Total payments. Add lines 23a through 23c .
23d
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24
Tax due. Subtract line 23d from line 22. See instructions for depository method of payment .
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Overpayment. Subtract line 22 from line 23d
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25
1
At any time during the 2012 calendar year, did the organization have an interest in or a signature or
other authority over a financial account (such as a bank account, securities account, or other financial
account) in a foreign country? (see instructions)
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Yes
No
If “Yes,” enter the name of the foreign country
During the tax year, did the organization receive a distribution from, or was it the grantor of, or transferor
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to, a foreign trust? If “Yes,” the organization may have to file Form 3520 .
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Yes
No
3
Enter the amount of tax-exempt interest received or accrued during the tax year
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$
4
Date organization formed
5a
The books are in care of
b
Enter name of candidate
c
The books are located at
d
Telephone No.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true,
Sign
correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
May the IRS discuss this return with
Here
the preparer shown below (see
instructions)?
Yes
No
Signature of officer
Date
Title
Print/Type preparer’s name
Preparer's signature
Date
PTIN
Check
if
Paid
self-employed
Preparer
Firm’s name
Firm's EIN
Use Only
Phone no.
Firm's address
1120-POL
For Paperwork Reduction Act Notice, see instructions.
Form
(2012)
Cat. No. 11523K

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