Form 43 - Nebraska Public Service Entity Tax Report - 2013 Page 60
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63NEBRASKA SCHEDULE 97 - Merger or Acquisition
for Use by All Public Service Entities
FORM 43
● If ownership has changed for any reason within the
Taxable Year
last year fill out the following questionnaire.
● Attach this schedule to Form 43
2013
Name and Address as Shown on Form 43
County
Type of business: _________________________________________________________________________________
Did the type of business change because of the transaction? If yes, how? ______________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Date of transaction: _______________________________________________________________________________
List the parties to the transaction:
Buyer:
Seller:
What relationship to each other did the parties have prior to the transaction? ____________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Briefly describe any other consideration or conditions of the agreement (special financing, special
contracts, etc. ___________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Was the entire operating unit involved in the transaction? If no, what was excluded? _____________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
What motivated the transaction?_____________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Briefly, how was the transaction allocated?
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Authorized by Section 77-801
96-189-99 Revised 11/2012
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