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120001PT1283
CY •
Alabama Department of Revenue
FORM
FY •
2012
PTE-C
Individual & Corporate Tax
SY •
Nonresident Composite Payment Return
For the year January 1-December 31, 2012 or other tax year beginning • _______________, 2012, ending • ________________, _______
Form PTE-C is used to report Alabama taxable income for all or some of the nonresident owners/shareholders from reported Subchapter K entity or S corporation income and to
make payment on behalf of the owners/shareholders in lieu of individual reporting. (CAUTION: Do not include losses on this form – see instructions.)
DEPARTMENT USE ONLY
FEDERAL EMPLOYER IDENTIFICATION NUMBER
FEDERAL BUSINESS CODE
Check applicable box:
•
•
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Subchapter K entity
NAME
•
•
S corporation
ADDRESS
•
Qualified Investment
Partnership
CITY
STATE
ZIP CODE
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Check if amended:
TOTAL NUMBER OF
NUMBER OF NONRESIDENT
IF YOU FILED A 2011 RETURN
•
OWNERS/
OWNERS/SHAREHOLDERS
WITH A DIFFERENT
Amended return
•
•
•
INCLUDED IN COMPOSITE FILING:
ADDRESS, CHECK HERE.
SHAREHOLDERS IN ENTITY:
DO NOT ATTACH TO OR MAIL WITH FORM 65 OR 20S, THIS FORM MUST BE MAILED SEPARATELY.
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1
1. Amount of tax due (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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2
2. Interest Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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3
3. Penalty Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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4
4. Total tax, interest, and penalty due. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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5a
5a. Overpayment from 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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5b
b. Estimated and automatic extension tax payments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c. Composite payment made on behalf of this entity.
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5c
Paid by • ___________________________________________________________ FEIN • ________________________________ . . . .
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5d
d. Total of all payments/credits (add lines 5a through 5c). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
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6. Amount to be remitted or (overpayment) (subtract line 5d from line 4). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If paid by check or money order, FORM BIT-V MUST ACCOMPANY PAYMENT.
If paid electronically check here
7a. Overpayment to be credited to 2013 return. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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7a
b. Overpayment amount to be refunded. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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7b
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I authorize a representative of the Department of Revenue to discuss my return and attachments with my preparer.
UNDER PENALTIES OF PERJURY, I declare that I have examined this return and accompanying schedules and statements and, to the best of my knowledge and belief, they
are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Please
Sign
(
)
Here
Your Signature
Title or Position
Daytime Telephone No.
Date
Date
Preparer’s PTIN
Preparer’s
•
•
Signature
Preparer’s
•
Printed Name
Paid
E.I. Number
Preparer’s
•
•
Firm’s Name (or yours,
Use Only
if self-employed)
Telephone Number
and Address
•
•
(
)
Email Address
Make remittance payable to: Alabama Department of Revenue
Mail to: Alabama Department of Revenue – PTE
Write – Form PTE-C, tax year, and FEIN on remittance for verification purposes.
P.O. Box 327444
Include with payment Form BIT-V available at
Montgomery, AL 36132-7444
ADOR