Form Int-4 - Credit Union Tax Return - 2012
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2012
MISSOURI DEPARTMENT OF REVENUE
P.O. BOX 898
INT-4
JEFFERSON CITY, MO 65105-0898
(573) 751-2326
TDD 1-800-735-2966
(Rev. 09-2012)
CREDIT UNION TAX RETURN
2013 TAXABLE YEAR BASED ON THE 2012 CALENDAR YEAR INCOME PERIOD
DUE DATE April 15, 2013
NAME
ADDRESS
CITY, STATE, ZIP CODE
FEDERAL EMPLOYER IDENTIFICATION NUMBER
COUNTY NAME
COUNTY CODE
___ ___ ___ ___ ___ ___ ___ ___ ___
NOTE: A COPY OF THE NASCUS/NCUA CALL REPORT MUST BE ATTACHED.
PART I
1.
Total gross income from NASCUS/NCUA Call Report as of December 31, 2012 .........................................
1
ADDITIONS
2.
Recoveries of bad debts from call report ........................................................................................................
2
3.
Missouri Credit Union tax expensed on call report .........................................................................................
3
4.
Missouri taxes claimed as credits on this return from Schedule A .................................................................
4
5.
Other additions (attach detailed schedule) .....................................................................................................
5
6.
Total of Lines 1 through 5 ...............................................................................................................................
6
PART II
DEDUCTIONS
7.
Total operating expenses from NASCUS/NCUA Call Report as of December 31, 2012 ...............................
7
8.
Dividends and interest paid on general shares from call report .....................................................................
8
9.
Loans charged off as bad debts from call report ............................................................................................
9
10.
Other deductions (complete detailed schedule on page 2) ............................................................................
10
11.
Total of Lines 7 through 10 .............................................................................................................................
11
12.
Taxable income (Line 6 less Line 11) .............................................................................................................
12
PART III
COMPUTATION OF TAX
If apportionment required, see instructions.
13.
Tax — Line 12 multiplied by 7% or from apportionment schedule .................................................................
13
14.
Tax credits from Line 4 above ........................................................................................................................
14
15.
Tax due (Line 13 less Line 14) .......................................................................................................................
15
16A. Less tentative payment or amount previously paid ........................................................................................
16A
16B. Miscellaneous credits (attach schedule and approved authorizations) ..........................................................
16B
16C. Enterprise Zone Credit (attach certificate of eligibility) ...................................................................................
16C
17.
Overpayment of previous year’s tax ...............................................................................................................
17
18.
Balance due or overpaid (Line 15 less Lines 16A, 16B, 16C, and 17) ...........................................................
18
19.
Interest for delinquent payment after April 15, 2013 (see instructions) ..........................................................
19
20.
TOTAL AMOUNT DUE OR OVERPAYMENT TO BE REFUNDED (Line 18 plus Line 19) ...........................
20
DOR-INT-4 (09-2012)
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