Form D-65 - Partnership Return Of Income - 2011 Page 2
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2D-65 PAGE 2
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*110650120002*
Business Name:
Federal Employer Identification No.:
WHOLE DOLLAR AMOUNTS ONLY
$
1
Gross receipts or sales, minus returns and allowances
1
$
2
Cost of goods sold and/or operations
2
$
3
Gross profit
3
Line 1 minus Line 2.
Fill in if minus:
$
4
Ordinary income (loss) from other partnerships,
4
Fill in if minus:
estates and trusts, etc.
$
5
Net farm profit (loss)
5
Fill in if minus:
$
6
Net gain (loss)
6
Fill in if minus:
$
7
Other income (loss)
7
Fill in if minus:
$
8
Total income
Add Lines 3–7
8
Fill in if minus:
$
9
Salaries and wages paid to non partners
9
$
10 Payments to partners
10
$
11 Repairs and maintenance
11
$
12 Bad debts
12
$
13 Rent
13
$
14 Taxes and licenses
14
$
15 Interest
15
$
16
16 Depreciation, minus depreciation deducted elsewhere on this return
$
17
17 Depletion
$
18
18 Retirement plans
$
19
19 Employee benefit programs
$
20
20 Other deductions
$
21
21 Total deductions
Add Lines 9–20
$
22
22 Ordinary income (loss)
Line 8 minus Line 21
Fill in if minus:
Under penalties of law, I declare that I have examined this return and, to the best of my knowledge, it is correct.
PLEASE
Declaration of paid preparer is based on all information available to the preparer.
SIGN
HERE
Partner or member’s signature
Date
Telephone number of person to contact
Preparer’s signature (if other than taxpayer)
Date
PAID
PREPARER
Paid Preparer’s PTIN
ONLY
Firm name
If you want to allow the paid preparer to discuss this return
with the Office of Tax and Revenue fill in the oval.
Firm address
Mail return to: Office of Tax and Revenue, 1101 4th Street, SW, FL4, Washington DC 20024
Make no payment with this return.
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2011 D-65 P2
Partnership Return of Income page 2
Revised 11/11
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