Form Ia 1120 - Iowa Corporation Income Tax Return - Long Form - 2001 Page 2
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4IA1120 Page 2 2001
Schedule A - Other Additions and Reductions
Enter Whole Dollars
Type of Income
Other Additions
Other Reductions
1 Percentage Depletion
2 TIP Credit
3 Capital Loss Adjustments (for filing status 2 or 3 only)
4 Contribution Adjustments (for filing status 2 or 3 only)
5 Safe Harbor Lease
a. Rent
b. Interest
c. Depreciation
6 Tax Exempt Interest and Dividends(see instructions)
7 Iowa Tax Expense/Refund
8 Work Opportunity Credit Wage Reduction
9 Alcohol Fuel Credit
s
10 Foreign Dividend Exclusion (from Schedule B)
11 Federal Securities Interest and Dividends
(instructions)
s
s
12 Other (must attach schedule)
13
TOTALS
(Enter total on line 3 of page 1)
(Enter total on line 6 of page 1)
Schedule B - Foreign Dividend Exclusion
Enter Whole Dollars
Type of Dividend Income
Total Dividend
Exclusion
1 Less than 20% Owned
x 70%
2 20% to 80% Owned
x 80%
3 More than 80% Owned
x 100%
4 Dividend Gross Up (federal section 78)
x 100%
5
TOTAL
(add lines 1 through 4)
Enter Total on line 10 of Schedule A
Schedule C1 - Credits
Schedule C2 - Payments
Whole Dollars
Whole Dollars
Description
Amount
Description
Amount
s
1 Motor Fuel Credit (attach IA4136)
1 Estimated Tax Payments
s
2 Iowa Jobs Credit (attach IA133)
a Credit from prior period overpayment
s
3 Research Activities Credit
b First, Date Paid:
(attach IA128 or 128A)
s
4 Minimum Tax Credit (from IA8827, page 4)
c Second, Date Paid:
5 Investment Tax Credit (attach IA 3468)
d Third, Date Paid:
6 Franchise Tax Credit
e Fourth, Date Paid:
7 Assistive Device Tax Credit
f Other, Date Paid:
8 Property Rehabilitation Tax Credit
2 Voucher Payment
9 Property Rehabilitation Credit (discounted)
3 Other Payments
10 Total (add lines 1-9) Enter on Page 1, line 20
4 Total (add lines 1-3) Enter on page 1, line 21
Additional Information
1. Year business was started in Iowa: __________
2. Last period filed as S corporation (if any) _____________
3. Information from the prior period Iowa return:
Corporation Name: _______________________________________________________________________________________
s
s
Net Income/Loss: ___________________________
Federal T.I.N.: ____________________________________
4. If part of a Federal consolidated group, please provide information about the corporate parent:
s
Corporation Name: ___________________________________
Federal T.I.N. _____________________________________
Under penalties of perjury, I declare that I have examined this return, any attached schedules/statements, and, to the best of my knowledge, believe it to be true,
correct and complete. If prepared by a person other than the taxpayer, the declaration is based on all information of which there is any knowledge.
Officer’s Signature __________________________________________ Title __________________________ Date ______________________
Signature of Preparer Other than Taxpayer _____________________________________________________ Date ______________________
Name and Address of Preparer or Preparer’s Employer
__________________________________________________________ Preparer’s Telephone No.: ________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________ Preparer’s ID No.: ________________________________________________________
s
42-001b
(08/27/01)
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