Form 63 Fi - Financial Institution Excise Return
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Form 63 FI
Financial Institution Excise Return
Massachusetts
Department of
Revenue
For calendar year 2013 or taxable period beginning
2013 and ending
Name of corporation
Federal Identification number
State or country of incorporation
3
3
Principal address
City/Town
State
Zip
Principal Massachusetts address
City/Town
State
Zip
Federal business code
Name of treasurer
Date of incorporation or charter
First date of business in Massachusetts
3
3
3
Name of common parent corporation
FID number of parent corporation
Most recent year audited by IRS
Have the adjustments been reported to Mass.?
Yes
No
3
3
U.S. return filed:
Is the corporation participating in the filing of a U.S. consolidated return?
1120
1120-REIT
1120S
Other:
Yes
No
Is the taxpayer an S corporation?
Is the corporation participating in the filing of a Massachusetts unitary return?
3
3
Yes
No
Yes
No
3
Corporation (check one only):
3
Alternate apportionment requested?
Is this return being filed by FDIC?
New
Terminated
Has predecessor
Has successor
Yes
No
Yes
No
3
If predecessor or successor: Name of corporation
3
Federal Identification number
3
State or country of incorporation
3
Principal address
City/Town
State
Zip
See instructions if part of a Massachusetts unitary group.
Excise Tax Calculation.
1 Income taxable in Massachusetts (from Schedule A, line 18) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1
Use whole dollar method
2 Financial institutions that are not S corporations, multiply line 1 by 9% (.09). S corporations, see instructions . . . . . . . . . . . 3 2
3 S corporations, enter total receipts (from Schedule S, line 17) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 3
4 If taxpayer is an S corporation and line 3 is $6 million or more but less than $9 million, multiply line 1 by 2.5% (.025) . . . . . 3 4
5 If taxpayer is an S corporation and line 3 is $9 million or more, multiply line 1 by 3.75% (.0375) . . . . . . . . . . . . . . . . . . . . . . 3 5
6 Credit recapture (enclose Schedule H-2) and/or additional tax on installment sales. See instructions . . . . . . . . . . . . . . . . . . 3 6
7 Excise due before credits. Add line 2, 4 or 5, whichever applies, to line 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 7
8 Economic Opportunity Area Credit (enclose Schedule EOAC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 8
9 Economic Development Incentive Program Credit. Certificate number 3
. . . . . . . . . . . . . . . 3 9
10 Low-Income Housing Credit. Building Identification number 3
. . . . . . . . . . . . . . . . . . . . . . 3 10
11 Historic Rehabilitation Credit. Certificate number 3
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 11
12 Film Incentive Credit. Certificate number 3
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 12
13 Medical Device Credit. Certificate number 3
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 13
14 Brownfields Credit. Certificate number 3
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 14
15 Employer Wellness Credit Credit. Certificate number 3
. . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 15
16 Life Science Company Tax Credit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 16
17 Total credits. Add lines 8 through 16. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 17
18 Excise after credits. Subtract line 17 from line 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
19 Minimum excise (cannot be prorated; unitary filers, see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 19
20 Excise due before voluntary contribution (line 18 or line 19, whichever is greater) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 20
21 Voluntary contribution for endangered wildlife conservation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 21
22 Excise due plus voluntary contribution. Add lines 20 and 21. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 22
Under penalties of perjury, I declare that to the best of my knowledge and belief, this return and enclosures are true, correct and complete.
Signature of appropriate officer
Date
Social Security number
Telephone number
Signature of paid preparer
Date
Employer ID number
Address
The Privacy Act Notice is available upon request. If you are signing as an authorized delegate of the appropriate officer, check here
and enclose
Massachusetts Form M-2848, Power of Attorney. Mail to: Massachusetts Department of Revenue, PO Box 7052, Boston, MA 02204.
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