California Form 568 - Limited Liability Company Return Of Income - 2014 Page 3
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7(continued from Side 2)
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X Is this LLC a direct owner of an entity that filed a federal Schedule M-3? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
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Y Does the LLC have a beneficial interest in a trust or is it a grantor of a Trust? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
If “Yes,” attach schedule of trusts and federal identification numbers.
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Z Does this LLC own an interest in a business entity disregarded for tax purposes?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
If “Yes,” complete Schedule EO, Part II.
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AA Is any member of the LLC related (as defined in IRC Section 267(c)(4)) to any other member of the LLC? . . . . . . . . . . . . . . . . . . .
Yes
No
BB Is any member of the LLC a trust for the benefit of any person related (as defined in IRC Section 267(c)(4))
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to any other member? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
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CC (1) Is the LLC deferring any income from the disposition of assets? (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
(2) If “Yes,” enter the year of asset disposition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
DD Is the LLC reporting previously deferred Income from:
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(see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Installment Sale
IRC §1031
IRC §1033
Other
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EE (1) Did this LLC generate a New Employment Credit? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
.
00
(2) If “Yes,” enter the generated amount. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
FF “Doing business as” name. See instructions: . . . . . . . . . . . . . . . .
_____________________________________________________________________
GG (1) Has this LLC operated as another entity type such as a corporation, S corporation, General Partnership,
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Limited Partnership, or Sole Proprietorship in the previous five (5) years? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
(2) If “Yes”, provide prior FEIN(s) if different, business name(s), and entity type(s) for prior returns
filed with the FTB and/or IRS (see instructions): _________________________________________________________________________________
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HH (1) Has this LLC previously operated outside California? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
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(2) Is this the first year of doing business in California?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
Federal TIN/SSN
Single Member LLC Information and Consent — Complete only if the LLC is disregarded.
Sole Owner’s name (as shown on owner’s return)
FEIN/CA Corp no./CA SOS File no.
Return filed with the FTB by the Owner
Street Address, City, State, and ZIP Code
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(1) Form 540
(5) Form 541
Member’s Consent Statement: I consent to the jurisdiction of the State of California to tax my LLC income and agree to file returns and pay tax
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(2) Form 100
(6) Form 100S
as may be required by the Franchise Tax Board.
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(3) Form 565
(7) Form 568
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(4) Other _________________
Signature
Date
Title
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is
true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Date
Sign
Signature
Here
Telephone
of officer
(
)
Officer’s email address (optional)
Date
PTIN
Paid
Check if
preparer’s
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self-employed
Paid
signature
Preparer’s
FEIN
-
Use Only
Firm’s name (or yours,
if self-employed)
Telephone
and address
(
)
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May the FTB discuss this return with the preparer shown above (see instructions)?. . . . . . . . . .
No
Yes
Form 568
2014 Side 3
3673143
C1
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