Form It 4708 - Composite Income Tax Return For Certain Investors In A Pass-Through Entity - 2012 Page 6

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IT 4708

Rev. 12/12

2012

Composite Income Tax

12160606

Return for Certain

FEIN

Investors in a

Pass-Through Entity

SCHEDULE V – INVESTOR INFORMATION...cont.

Provide investor information for all (resident and nonresident) investors in the pass-through entity. List investors by highest to lowest ownership percent-

age. Use an additional sheet, if necessary. See “Important Notes” on page 8 of this return for distributive share information.

First name/entity

M.I.

Last name

Address

City

State

ZIP code

Social Security no./FEIN

Percent of ownership

Tax amount paid

First name/entity