Corporation Application for Adjustment
FORM 4466N
of Overpayment of Estimated Income Tax
2012
for the taxable year January 1, 2012 through December 31, 2012 or other taxable year
,
beginning
, 2012 and ending
Corporation Name Doing Business As
PLEASE DO NOT WRITE IN THIS SPACE
RESET
PRINT
Legal Name
Street or Other Mailing Address
City
State
Zip Code
Is this application being filed by the 15th day of the third month following the end of the tax year?
Nebraska ID Number
Federal ID Number
If No, see instructions.
24 —
YES
NO
1 Estimated corporation income tax before nonrefundable credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2 Estimated premium tax paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
3 Estimated other nonrefundable credits — CDAA credit and Form 3800N credit . . . . .
3
4 Estimated total nonrefundable credits (total of lines 2 and 3). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
5 Estimated income tax liability (line 1 minus line 4. If less than zero, enter -0-). . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
6 Estimated Form 3800N refundable credit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
7 Beginning Farmer credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
8 Estimated income tax liability (line 5 minus lines 6 and 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
9 2012 estimated tax payments (include 2011 overpayment credited to 2012 estimated tax) . . . . . . . . . . . . . . . . . 9
10 OVERPAYMENT of estimated tax claimed (line 9 minus line 8). If this amount is at least 10% of line 8 and
at least $500, the corporation may request this adjustment . Lines 11a, 11b, and 11c must be completed. . . 10
11a Routing Number
11b Type of Account
1 = Checking
2 = Savings
11c Account Number
11d
Check this box if this refund will go to a bank account outside the United States.
Under penalties of perjury, I declare that I have examined this application including any accompanying schedules and statements,
and to the best of my knowledge and belief, it is correct and complete.
sign
here
Signature of Officer
Title
Date
Phone Number
Email Address
Mail this application to: NEBRASKA DEPARTMENT OF REVENUE, PO BOX 94818, LINCOLN, NE 68509-4818.
, 800-742-7474 (NE and IA), 402-471-5729
8-390-2012
1
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