Form Pte-C - Alabama Nonresident Composite Payment Return - 2014 Page 3

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SCHEDULE

140003PT

Entity’s FEIN

PTE-CK1

2014

lAbAmA

epArtment of

evenue

For the year January 1 - December 31, 2014 or other tax year beginning ___________________, 20_____ ending ___________________, 20_____

(D) Owner’s/

(E) Owner’s/ Shareholder’s

(H) Owner’s/

(A) Non-Resident Owner’s/Shareholder’s Name,

(B) Social Security

Shareholder’s

Share of Nonseparately

(F) Guaranteed

(G) Total Income

Shareholder’s

Percentage of

Stated Income +

Share of Tax Due

Street Address, City, State, and ZIP

Number/FEIN

Type

Payments

(Col. E + F)

Ownership

Portfolio Income

(Col. G X 5%)

Totals page 3 [columns (E) through (H)] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Summary totals for additional pages [columns (E) through (H)]. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Totals [columns (E) through (G)] (lines 12 + 13) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

14H

Add lines 12 and 13, column (H) and enter here and on page 1, line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

IF MORE THAN 11 NON-RESIDENT OWNERS/SHAREHOLDERS, ATTACH ADDITIONAL PAGES AND ENTER SUMMARY TOTALS ON LINE 13 ABOVE.

Form PTE-C, Page 3

ADOR