Form 4t - Wisconsin Exempt Organization Business Franchise Or Income Tax Return - 2011 Page 2
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32011 Form 4T
Page
2 of 3
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19 Tax from tax table on amount on line 18. This is gross tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
00
.
20 Nonrefundable credits (from Schedule CR, line 6 plus line 19) . . . . . . . . . . . . . . . . . . . . . . . . 20
00
.
21 Net income tax paid to other states . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
00
.
22 Add lines 20 and 21 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
00
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23 Subtract line 22 from line 19. If line 22 is greater than line 19, enter zero (0). This is net tax . . . 23
00
.
24 Tax from line 13 or 23 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
00
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25 Economic development surcharge (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
00
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26 Endangered resources donation (decreases refund or increases amount owed) . . . . .
00
26
.
27 Veterans trust fund donation (decreases refund or increases amount owed) . . . . .
00
27
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28 Add lines 24 through 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
00
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29 Estimated tax payments less refund from Form 4466W. . . 29
00
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30 Wisconsin tax withheld . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
00
23
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31 Refundable credits (from Schedule CR, line 29 or line 51) 31
00
.
32 Amended Return Only – amount previously paid . . . . . . . . 32
00
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33 Add lines 29 through 32 . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
00
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34 Amended Return Only – amount previously refunded . . . . 34
00
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35 Subtract line 34 from 33 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
00
36 Interest, penalty, and late fee due (from Form 4U, line 17 or 26).
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If you annualized income on Form 4U, check () the space after the arrow . . . . . . . . .
00
36
37 Tax due. If the total of lines 28 and 36 is larger than line 35, subtract line 35 from the total of
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lines 28 and 36 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
00
38 Overpayment. If line 35 is larger than the total of lines 28 and 36, subtract the total of lines
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28 and 36 from line 35 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
00
.
Enter amount of line 38 you want credited on 2012 estimated tax
. . 39
00
39
.
40 Subtract line 39 from line 38. This is your refund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
00
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41 Enter total gross receipts from all unrelated trade or business activities . . . . . . . . . . . . . . . . . 41
00
Additional Information Required
1 Person to contact concerning this return:
Phone #:
Fax #:
2 City and state where books and records are located for audit purposes:
3 Are you the sole owner of any limited liability companies (LLCs)?
Yes
No
If yes, attach a list of the names and federal EINs
of your solely owned LLCs. Did you include the incomes of these entities in this return?
Yes
No
4 Did you purchase any taxable tangible personal property or taxable services for storage, use, or con s umption in Wisconsin without payment
of a state sales or use tax?
No
If yes, you may owe Wisconsin use tax. See instructions for how to report use
Yes
tax. (You will not be liable for Wisconsin use tax if you hold a Wisconsin Certificate of Exempt Status.)
5 Did any adjustments made by the Internal Revenue Service to your income for prior years become finalized during this year?
Yes
No
If yes, see instructions and indicate years adjusted:
6 List the locations of your Wisconsin operations:
Under penalties of law, I declare that this return and all attachments are true, correct, and complete to the best of my knowledge and belief.
Signature of Officer or Trustee
Title
Date
Preparer’s Signature
Preparer’s Federal Employer ID Number
Date
You must file a copy of your federal Form 990-T or 4720, including attachments, with your Form 4T.
If you are not filing your return electronically,
make your check payable to and mail your return to:
Wisconsin Department of Revenue
PO Box 8908
Madison WI 53708-8908
Go to Page 3
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