Form 40 - Corporation Income Tax Return - 2011 Page 2
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8North Dakota Office of State Tax Commissioner
2011 Form 40, page 2
Name as shown on return
Federal employer I.D.
Schedule SA: Statutory adjustments
This schedule is to be used by all corporations regardless of filing method.
Additions
(CA) 1
1
Federal net operating loss deduction
(Federal Form 1120, line 29a)
Special deductions
(CB) 2
2
(Federal Form 1120, line 29b)
3
All income taxes, franchise or privilege taxes measured by income, which were deducted to determine
(CC) 3
federal taxable income
(CF) 4
4
Interest on state and local obligations
(Excluding North Dakota obligations)
C
(CD) 5
ontribution to endowment fund credit adjustment
5
C
(CE) 6
ontribution to housing incentive fund credit adjustment
6
(CQ) 7
Domestic production activity deduction
7
Other additions
(CG) 8
8
(Attach worksheet)
9
9
Total additions
(Add lines 1 through 8. Enter amount here and on Form 40, page 1, line 2)
Subtractions
(CH) 10
Tax refunds received in 2011
10
(Attach worksheet)
(CI) 11
11
Interest on United States obligations
(Attach statement regarding obligations)
(LS) 12
12
Allocable income (Attach worksheet)
(LT) 13
13
Related expenses (Attach worksheet)
(LD) 14
Balance (Subtract line 13 from line 12)
14
(CM) 15
IC-DISC distribution to a non-corporate owner (see instructions)
15
(CO) 16
16
Others subtractions
(Attach worksheet)
17
Total subtractions
17
(Add lines 10, 11, 14, 15 and 16. Enter amount here and on Form 40, page 1, line 3)
The following questions must be answered
No
Yes
®
1
Has the IRS issued a Final Determination which affects any previously filed North Dakota return?
1
®
2
If the answer to the above question is yes, have all such adjustments been reported to North Dakota?
2
®
3
Is this return for a tax-exempt organization required to report unrelated business taxable income?
3
Has this corporation filed as a cooperative, a Foreign Sales Corporation, or a Domestic International
4
®
4
Sales Corporation for federal purposes?
Does this corporation use the combined report method in any other states? If yes, attach a statement showing
5
®
5
all states where the combined report method is used.
Does this corporation file its federal income tax return as a member of a
6
consolidated group? If yes, please enter the Federal Employer I.D. No. under
(AM)
®
which the consolidated return is filed.
6
Does the numerator of the apportionment factor on page 1, line 5 include the property, payroll and/or sales of
7
®
7
more than one corporation required to file in this state? If yes:
Filing method circle on page 1, line 1 must have been marked b1 or c1.
®
How many corporations are included in the numerator?
Complete North Dakota Schedule CR, Parts I, II and III reporting the activities of each
company apportioning income to North Dakota.
®
8
Is this a limited liability company?
8
Are any single member LLC's included in corporations reporting on this return?
9
®
(If yes, attach worksheet with names and Federal Employer I.D. Numbers of all single member LLC's)
9
Is this corporation or any of its affiliates included in this return considered to be a captive real estate
10
investment trust (REIT)? (If yes, attach worksheet with names and Federal I.D. numbers of all captive
®
REITS)
10
Has this corporation changed names, been involved in a merger, reorganization or takeover
11
®
during this tax year? If so, provide former name and details of change.
(former name)
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