Form M4x - Amended Franchise Tax Return/claim For Refund
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4M4X
Amended Franchise Tax Return/Claim for Refund
Use only to amend your return for tax years prior to 2010 .
For tax year beginning (mo/yr)
and ending (mo/yr)
Minnesota tax ID
Are you filing as a member
of a unitary group?
Yes
No
If yes, did you file a
Name of corporation
FEIN
single combined return?
Yes
No
Are you filing an amended
Street address or post office box
federal return (1120X)?
Yes
No
If yes, attach a complete copy .
City
State
Zip code
Check boxes that apply:
Change in
Cooperative
estimated tax
Check the type of return being amended
Date original return was filed
Exempt organization
IRS adjustment
Other
M4
Other
Net operating loss
A
B
C
As previously reported
Net change
Corrected amounts
1
1 Minnesota net income or (loss) (from line 7 on back) . . . . . . . . .
2
2 Nonapportionable income or (loss) . . . . . . . . . . . . . . . . . . . . . . .
3
3 Minnesota apportionable income (subtract line 2 from line 1) .
4
4 Apportionment factor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
5 Net income apportioned to Minnesota (multiply line 3 by line 4) . .
6
6 Minnesota nonapportionable (income) or loss (see line 6 inst .) .
7
7 Net operating loss deduction (15-year carryforward only) . . . . .
8
8 Deduction for dividends received . . . . . . . . . . . . . . . . . . . . . . . . .
9
9 Contributions deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
10 Add lines 6, 7, 8 and 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
11 Taxable income (subtract line 10 from line 5) . . . . . . . . . . . . . . .
12
12 Regular franchise tax (see line 12 instructions for rate) . . . . . . .
13
13 Alternative minimum tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(
)
(
)
14
14 Alternative minimum tax credit . . . . . . . . . . . . . . . . . . . . . . . . . . .
(
)
(
)
15
15 Minnesota research credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
16 Minimum fee (from 1990 forward) . . . . . . . . . . . . . . . . . . . . . . . .
17
17 Subtotal (add lines 12 through 16) . . . . . . . . . . . . . . . . . . . . . . .
18
18 Employer transit pass credit, limited to amount on line 17C . . .
19 Enterprise zone, biotechnology, JOBZ
19
and/or cattle tuberculosis testing credits . . . . . . . . . . . . . . . . . .
20
20 Total liability (subtract lines 18 and 19 from line 17) . . . . . . . . .
21 If line 20B is more than zero, enter interest due on additional tax
21
(see line 21 instructions for rate) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
22 Add lines 20B and 21 . This is your TOTAL AMOUNT DUE . . . . . . . . . . . . . . . . . . . . . . . .
Check payment method:
Electronic
Check
(payable to Minnesota Revenue and attach PV64)
I declare that this return is correct and complete to the best of my knowledge and belief .
Authorized signature
Title
Date
Daytime phone
I authorize the
Minnesota
Signature of preparer
PTIN
Date
Daytime phone
Department
of Revenue to
discuss this tax
Print name of person to contact within corporation to discuss this return
Title
Daytime phone
return with the
preparer .
Explain net changes on a separate sheet and include it with this return. Show computations in detail and attach any schedules
needed . Mail to: Minnesota Revenue, Mail Station 1255, St . Paul, MN 55146-1255 .
Stock No . 4000040 (Rev . 4/11)
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