Form 1120-Sf - U.s. Income Tax Return For Settlement Funds (Under Section 468b)

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1120-SF
U.S. Income Tax Return for Settlement Funds
Form
(Under Section 468B)
OMB No. 1545-1394
(Rev. December 2011)
Department of the Treasury
For calendar year 20
Internal Revenue Service
Name of fund
Employer identification number of fund (see instructions)
Number, street, and room or suite no. (If a P.O. box, see instructions.)
City or town, state, and ZIP code
Name and address of administrator (defined on page 3 of the instructions)
Check applicable boxes:
(1)
Final return
(2)
Name change
(3)
Address change
(4)
Amended return
Part I
Income and Deductions (see instructions)
1
1
Taxable interest
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2
2
Dividends
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3
Capital gain net income (attach Schedule D (Form 1120)) .
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3
4
Items of income or gain from a partnership interest .
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4
5
5
Other income (attach schedule)
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6
Gross income. Add lines 1 through 5
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6
7
Trustee/administrator fees .
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7
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Taxes .
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9
Accounting and legal services (attach schedule) .
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9
10
Notification of claimants and claim processing expenses .
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10
11
11
Other deductions (attach schedule) .
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12
12
Net operating loss deduction .
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13
Total deductions. Add lines 7 through 12 .
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13
Part II
Tax Computation (see instructions)
14
Modified gross income. Subtract line 13 from line 6 .
14
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15
Total tax. Enter 35% of line 14
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15
16
Credits and payments:
a Overpayment from prior year allowed as
a credit
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16a
b Current year estimated tax payments
16b
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c Refund
of
overpaid
estimated
tax
applied for on Form 4466
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16c
d Subtract line 16c from the total of lines 16a and 16b
16d
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e Tax deposited with Form 7004
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16e
f
Total credits and payments (add lines 16d and 16e) .
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16f
17
17
Estimated tax penalty (see instructions). Check if Form 2220 is attached .
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18
Tax due. If the total of lines 15 and 17 is more than line 16f, enter amount owed .
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18
19
Overpayment. If line 16f is more than the total of lines 15 and 17, enter amount overpaid
19
20
Enter amount of line 19 you want: Credited to next year’s estimated tax
Refunded
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20
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true,
Sign
correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
May the IRS discuss this return
Here
with the preparer shown below
Yes
No
(see instructions)?
Title
Signature of fund administrator
Date
Print/Type preparer’s name
PTIN
Preparer’s signature
Date
Paid
Check
if
self-employed
Preparer
Firm’s name
Firm's EIN
Use Only
Firm’s address
Phone no.
1120-SF
For Paperwork Reduction Act Notice, see separate instructions.
Form
(Rev. 12-2011)
Cat. No. 14989I

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