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FORM NFC
Statement of Nebraska Financial Institution Tax Credit
2013
FINANCIAL INSTITUTION’S NAME AND MAILING ADDRESS
SHAREHOLDER’S NAME AND MAILING ADDRESS
Name
Name
Street or Other Mailing Address
Street or Other Mailing Address
City
State
Zip Code
City
State
Zip Code
Nebraska ID Number
Federal ID Number
Social Security Number
Spouse’s Social Security Number
Taxable Year of Financial Institution
Financial Institution Tax Credit (from Shareholder’s
Schedule, Column I, Form 1120NF) ........................... $
Beginning
, 20
and Ending
, 20
Provide this statement to the shareholder.
Form NFC must be filed with the shareholder’s Nebraska Individual Income Tax Return, Form 1040N.
Please retain a copy for your records.
Instructions
Who Must File. Every financial institution organized as an S corporation must complete a Statement of Nebraska Financial Institution
Tax Credit, Form NFC, for each shareholder. If the financial institution is owned by an S corporation bank holding company, list
the shareholders of the holding company. This statement must be provided to the shareholder. Do not file it with the Nebraska
Financial Institution Tax Return, Form 1120NF. The individual shareholder must attach this statement to his or her Nebraska
individual income tax return to claim the credit.
Joint Ownership. If shares are jointly owned, separate Forms NFC must be issued to each joint owner reflecting each owner’s
proportionate share of the credit.
Amount of Credit. Enter the individual shareholder’s amount of calculated credit from Column I, Shareholder’s Schedule,
Form 1120NF. Do not enter the total amount of the tax paid by the financial institution.
8-632-2013