Form Pte-C - Nonresident Composite Payment Return/schedule Pte-Ck1 - 2012 Page 4
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4Reset Schedule
SCHEDULE
120004PT1283
Entity’s FEIN
PTE-CK1
2012
A
D
R
LABAMA
EPARTMENT OF
EVENUE
For the year January 1 - December 31, 2012 or other tax year beginning ___________________, 20_____ ending ___________________, 20_____
(D) Owner’s/
(E) Owner’s/Shareholder’s
(H) Owner’s/
(A) Non-Resident Owner’s/Shareholder’s Name,
(B) Social Security
(C) Entity
Shareholder’s
Share of Nonseparately
(F) Guaranteed
(G) Total Income
Shareholder’s
Percentage of
Stated Income +
Share of Tax Due
Street Address, City, State, and ZIP
Number/FEIN
Type
Payments
(Col. E + F)
Ownership
Portfolio Income
(Col. G X 5%)
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13 Add lines 1 through 12, enter here and on Form PTE-C, page 3, line 13, columns (E) through (H). . . . . . . . . . . . . . . . . . . . . . . . . .
ADOR
Additional page _________
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