M4X page 2
13492
2013 Amended Franchise Tax Return/Claim for Refund
(continued)
Name of corporation/designated filer
FEIN
Minnesota tax ID
30
30 Amount from line 29 (total credits and tax paid) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
31
31 Refund amount from original Form M4, line 17 (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
32
32 Subtract line 31 from line 30 (if result is less than zero, enter the negative amount) . . . . . . . . . . . . . . . . .
33
33 Amount from line 22C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
34 Tax you owe. If line 33 is more than line 32, subtract line 32 from line 33
34
(if line 32 is a negative amount, see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
35
35 If you failed to timely report federal changes or the IRS assessed a penalty (see instructions) . . . . . . . . .
36
36 Add line 34 and line 35 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
37
37 Interest (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
38
38 AMOUNT DUE (add lines 36 and 37) . Skip line 39 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Check payment method:
Electronic (see instructions)
Check (attach PV64)
39
39 REFUND . If line 32 is more than line 33, subtract line 33 from line 32 . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If you have a refund, you must enter your banking information below.
Account type:
Routing number
Account number
(use an account not associated with any foreign accounts)
Checking
Savings
I declare that this return is correct and complete to the best of my knowledge and belief
Authorized signature
Title
Date
Daytime phone
I authorize the
Minnesota
Signature of preparer
PTIN
Date
Daytime phone
Department
of Revenue to
discuss this tax
Print name of person to contact within corporation to discuss this return
Title
Daytime phone
return with the
preparer .
Explain net changes below and show computations in detail. Enclose the list of changes, amended schedules and amended federal
Form 1120X, if any . Mail to: Minnesota Revenue, Mail Station 1255, St . Paul, MN 55146-1255 .
EXPLANATION OF CHANGE—Explain below each change in detail. If the changes involve items requiring supporting informa-
tion, be sure to attach the appropriate schedule, statement or form to Form M4X to verify the correct amount . If you need
more space, enclose another sheet .
9995
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