Virginia Schedule 500ab - Schedule Of Related Entity Add Backs And Exceptions - 2012

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2012
Schedule of Related Entity
*VA0IAB112000*
Virginia
Add Backs and Exceptions
Schedule 500AB
Name as shown on Virginia return ____________________________________ Federal Employer ID Number _______________________
Number of Related Entities _______________
Part I - Taxpayer’s Payments Made to Related Entities
Jurisdiction (State or Country)
Amount Paid to Related Entity For
Royalties or
Where
Of Commercial
Other Intangible
Name of Related Entity
FEIN
Organized
Domicile
Interest
Expenses
1.
1a
1b
2.
2a
2b
3.
3a
3b
4.
Total Interest / Intangible Expense Payments
4a
4b
Deduct Intangible Expense Payments Qualifying for Exceptions
5.
Exception 1
5
6.
Exception 2
6
7
7.
Exception 3
8.
Total Exception Amount - Add lines 5, 6 & 7. Enter here and on Form 500, Question A.
8
9.
Net Addition - Royalties or Other Intangibles - Line 4b minus Line 8.
9
10. Net Addition of Interest and Royalties - Enter the total of Lines 4a plus 9 here and on Schedule 500 ADJ, Section A, Line 3.
10
Part II - Exceptions Applicable to Royalties
Exception 1 (Subject to tax): For each related entity for which the taxpayer claims an exception, identify all states and
foreign countries in which the related entity paid a tax measured by net income or capital and attach a copy of the tax
returns filed (schedules and supplemental forms may be omitted). Show the portion of the tax paid by the related entity on
its separate return that is attributed to the royalties and other expenses related to intangible property. If the related entity
filed a consolidated or combined return in the other state or foreign country with the taxpayer, then the recipient’s income
and taxpayer’s deduction offset each other and no tax is deemed paid. If more space is needed, attach a separate sheet.
Tax Paid on the
Royalties & Other
List Each Jurisdiction
Royalties & Other
Intangible Income on
Total Qualifying
In Which Tax Paid
Type of Tax Paid
Intangible Income
Which Tax Paid
Royalties
Name of Related Entity
Gross Revenues of Related Entity
Name of Related Entity
Gross Revenues of Related Entity
Name of Related Entity
Gross Revenues of Related Entity
Name of Related Entity
Gross Revenues of Related Entity
Total Royalties Qualifying For Exception 1 (Also enter the amount in Part I, Line 5 ).
Attach Schedule 500AB to Your Virginia Corporation Return, Form 500
VA DEPT OF TAXATION 2601022 500AB F (REV 10/12)

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