Dealer In Intangibles Tax Return - 2011 Page 7
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202011
Form 980
Rev. 11/10
Dealer in Intangibles Tax Return
Consolidated
Single county
Inter-County
Account number
Check here if you are a “qualify-
Taxpayer name
ing dealer” (see R.C. 5725.24 and
5733.45). Generally, a qualifying
Address
dealer is a dealer in intangibles that
is a subsidiary of a fi nancial institu-
City
State
ZIP
tion or insurance company. If you are
a qualifying dealer, you do not need
Business name
to complete Ohio form 982.
Ohio county business location
Received Stamp
Date business started in Ohio
Description of Ohio business
Time Extension Permit
Ohio charter number
FEIN
Social Security number
No.
granted
April 13, 2011
Type of business:
Corporation
S corporation
Partnership
Other
To
1. Ohio proportion of taxable value of shares or invested capital (from Balance Sheet
or Exhibits A, B or C) ..........................................................................................................
$
2. Value of nontaxable bonds and securities as of date of conversion ..................................
$
3. Total taxable value in Ohio (line 1 plus line 2) rounded to the nearest $10 ......................
$
4. Tax payable (line 3 multiplied by .008) to nearest .01 ........................................................
$
5. Credit for eligible employee training costs .........................................................................
$
6. Venture capital tax credits
a. refundable credit ............................................................................................................
$
b. nonrefundable credit ......................................................................................................
$
7. Ohio historic preservation tax credit ...................................................................................
$
8. Total tax payable ................................................................................................................
$
Do not send a check with this tax return. You will be billed.
9. Penalty ..............................................................................................................................
$
The Department of Taxation must receive this tax return no later than March 14, 2011.
D.E. verifi cation
Declaration
I/we declare under penalties of perjury that this return (including any accompanying schedules and statements) has been
examined by me/us and to the best of my/our knowledge and belief is a true, correct and complete return and report.
Person, other than taxpayer, preparing this return Date
Signature of taxpayer
Title
Date
Address
Print name of taxpayer
Date
Phone number
Phone number
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