Form It 4708 - Composite Income Tax Return For Certain Investors In A Pass-Through Entity - 2012 Page 7

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IT 4708

Rev. 12/12

2012

Composite Income Tax

Return for Certain

12160706

FEIN

Investors in a

Pass-Through Entity

SCHEDULE V – INVESTOR INFORMATION...cont.

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

M.I.

Last name

Address

City

State

ZIP code

Social Security no./FEIN

Percent of ownership

Tax amount paid

SCHEDULE VI – REFUNDABLE BUSINESS CREDITS

1. Ohio historic preservation credit

.......................................................................................................... 1.

............................................................................................................................. 2.

2. Business jobs credit

3. Pass-through entity credit

.................................................................................................................... 3.

4. Losses on loans made to Ohio venture capital program

...................................................................... 4.

5. Motion picture production credit

........................................................................................................... 5.

6. Total refundable credits (enter here and on page 2, line 19

................................................................. 6.

Note: Certiﬁ cates from the Ohio Development Services Agency and/or Schedule K-1(s) must be attached to verify each refundable credit claimed.

QUESTIONNAIRE

Yes

N/A

1. If the pass-through entity is an S corporation, did the pass-through entity pay any compensation or remuneration to any

nonresident investors or nonresident members of the investor’s family? If yes, attach a list of those individuals (include

Social Security numbers) who received such compensation or remuneration and the amount(s) ...................................

2. If the pass-through entity is, or is treated as, a partnership for federal income tax purposes, did the pass-through entity

make any guaranteed payments to any of its partners or equity investors? If yes, attach a list of those partners or equity

investors (include Social Security numbers and federal employer identiﬁ cation numbers) who received such guaranteed

payments and the amount(s) ............................................................................................................................................

2012 IT 4708

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