Schedule Ks (Form 60) - Shareholder Information - 2013

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North Dakota Office of State Tax Commissioner
2013 Form 60, page 5
Enter name of corporation
FEIN
Schedule KS
Shareholder information
All corporations must
Complete Columns 1 through 5 for EVERY shareholder
complete this schedule
Complete Column 6 if shareholder is a nonresident individual or tax-exempt organization
If applicable, complete Column 7 or Column 8 for a nonresident individual shareholder only
All Shareholders
Column 1
Column 2
Column 3
Column 4
Share-
Name and address of shareholder
Social Security
Type of entity
Ownership
If additional lines are needed,
holder
Number/FEIN
%
(See pg. 8 of instr.)
attach additional pages
Name
A
State
Zip Code
Address
Name
B
Address
State
Zip Code
Name
C
State
Zip Code
Address
Name
D
Address
State
Zip Code
Name
E
State
Zip Code
Address
Name
F
State
Zip Code
Address
Name
G
Address
State
Zip Code
All Shareholders
Nonresident
Individuals and Tax
Nonresident Individual Shareholders Only
Complete this column for
Exempt Organizations
ALL shareholders
Column 5
Column 6
Column 7
Column 8
North Dakota
Federal distributive
North Dakota
North Dakota
Form PWA
income tax
share of income (loss)
distributive share of
(attach
composite income tax
Shareholder
withheld (3.22%)
income (loss)
copy)
(3.22%)
A
B
C
D
E
F
G
1 Total for Column 5 . . 1
2 Total for Column 6 . . . . . . . . . . . . . . . . . . . . . 2
3 Total for Column 7. Enter this amount on Form 60, page 1, line 2
3
. . . . . . . .
4 Total for Column 8. Enter this amount on Form 60, page 1, line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

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