Form Fae 170 - Franchise, Excise Tax Return
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8TENNESSEE DEPARTMENT OF REVENUE
Please do not staple
FRANCHISE, EXCISE TAX RETURN
Account No.
FEIN or SSN
Taxable Year
FAE
Beginning:
Due Date
170
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Ending:
AMENDED RETURN, please check
the box at right.
CHECK APPROPRIATE BLOCK(S):
j.
Series LLC/Series
FINAL RETURN for termination or
a.
Tennessee Domestic Corporation
k.
PLLC
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withdrawal, please check box at right.
b.
Foreign Corporation
l.
L P
c.
S Corporation
m.
LLP
d.
Insurance Company
n.
RLLP
Application of Public Law 86-272 to
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e.
LLC
o.
PRLLP
Excise Tax, please check box at
right.
f.
Single Member LLC/individual
p.
Business Trust
g.
Single Member LLC/corporation
q.
Not-For-Profit
Payment for this return was sent
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h.
Single Member LLC/general partnership r.
Other
_____________
via EFT, please check the box at
i.
Single Member LLC/Division of parent(see instructions)
right.
Taxpayer has made an election to
calculate net worth per the provi-
}
sions of Tenn. Code Ann. Section
67-4-2103(g)-(i), please check the
box at right.
Enter the principal business activity code (NAICS)
listed in federal IRC instructions that best de-
scribes the principal business activity in Tennes-
see.
Date Tennessee
If you use a paid
Operations Began
preparer and do not
want forms mailed
to you next year,
check box at right.
SCHEDULE A - COMPUTATION OF FRANCHISE TAX
DOLLARS
CENTS
1. Total net worth from Schedule F1, Line 5 or Schedule F2, Line 3 ......................................................................... (1) ______________________________
2. Total real & tangible personal property from Schedule G, Line 15 ....................................................................... (2) ______________________________
3. Franchise tax (25¢ per $100.00 or major fraction thereof on the greater of Lines 1 or 2; minimum $100.00) .. (3) ______________________________
SCHEDULE B - COMPUTATION OF EXCISE TAX
4. Income subject to excise tax from Schedule J, Line 33 ........................................................................................... (4) ______________________________
5. Excise tax (6.5% of Line 4) ..................................................................................................................................... (5) ______________________________
6. Add: Recapture of tax credit from Schedule T, Part 2 ............................................................................................ (6) ______________________________
7. Net excise tax due (Line 5 plus Line 6) ................................................................................................................ (7) ______________________________
SCHEDULE C - COMPUTATION OF TOTAL TAX DUE OR OVERPAYMENT
8. Total Franchise and Excise taxes - Add lines 3 and 7 ..........................................................
(8) ______________________________
9. Deduct: Total credit from Schedule D, Line 10 (cannot exceed Line 8) .............................
(9) ______________________________
10. Subtotal: Line 8 less Line 9 (if Line 9 exceeds Line 8, enter 0 here) ....................................
(10) ______________________________
11. Deduct: Total payments from Schedule E, Line 7 ..............................................................
(11) ______________________________
12. Penalty (5% for each 30-day period of delinquency not to exceed 25%; minimum penalty is $15)
(12) ______________________________
13. Interest (
% per annum on taxes unpaid by the due date) .............................................................................. (13) ______________________________
14. Penalty on estimated franchise, excise tax payments ........................................................................................... (14) ______________________________
15. Interest on estimated franchise, excise tax payments ........................................................................................... (15) ______________________________
16. Total amount due (overpayment) - Add lines 10, 12, 13, 14, and 15, less Line 11 ......................................... (16) ______________________________
If overpayment reported on Line 16, complete A and/or B:
A.
Credit to next year’s tax $ ___________________________
B.
Refund $ ______________________
Under penalties of perjury, I declare that I have examined this report, and to the best of my knowledge and belief, it is true, correct, and complete.
POWER OF ATTORNEY - Check YES if this
taxpayer's signature certifies that this tax preparer
_______________________________________________________________
__________________
_______________________________
Taxpayer's Signature
Date
Title
has the authority to execute this form on behalf
of the taxpayer and is authorized to receive and
_______________________________________________
_____________
__________________
_______________________________
inspect confidential tax information and to per-
Tax Preparer's Signature
Preparer's PTIN
Date
Telephone
form any and all acts relating to respective tax
_______________________________________________________
__________________________
________
____________________
matters.
YES
Preparer's Address
City
State
ZIP
Remit amount on Line 16, payable to:
RV-R0011001
TENNESSEE DEPARTMENT OF REVENUE
FOR OFFICE
Andrew Jackson State Office Building
USE ONLY
500 Deaderick Street, Nashville, TN 37242
INTERNET (12-12)
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