Form 502 - Pass-Through Entity Return Of Income And Return Of Nonresident Withholding Tax Page 2

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2013 Va.

*VA0PTE213888*

Name

Form 502

Federal Employer ID Number

Page 2

Section 1: Withholding Payment Reconciliation

1. Total withholding tax due for nonresident owners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.

.00

2. Total withholding tax paid (Entity's own payments only – see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.

.00

3. Overpayment (If Line 2 is greater than Line 1, subtract Line 1 from Line 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.

.00

4. Balance of tax due (If Line 2 is less than Line 1, subtract Line 2 from Line 1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.

.00

Section 2: Penalty and Interest Charges on Withholding Tax

5. Extension penalty (will apply if Line 4 is more than 10% of Line 1 and return is filed within extension period) . . . . 5.

.00

6. Late filing penalty (will apply if there is a balance due on Line 4 and Form 502 is being filed more

than six months after the original due date). Enter 30% of the amount on Line

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

.00

7. Interest (may apply if there is a balance due on Line 4) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.

.00

8. Total penalty and interest charges due (add Line 5 or Line 6 (whichever applies) to Line 7) . . . . . . . . . . . . . . . . . . 8.

.00

Section 3: Penalty for Late Filing of Form 502

9. If Form 502 is being filed more than six months after the original due date, or more than 30 days

after the federal extended due date, enter $1,200. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.

.00

Section 4: Disposition of Overpayment

10. Net overpayment. Compare Line 6 and Line 9. If Line 6 is greater than Line 9, subtract Line 8 from Line 3.

If Line 9 is greater than Line 6, subtract Line 7 and Line 9 from Line 3. If Line 8 or Line 9 exceeds

Line 3, go to Line 13 below . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.

.00

11. Amount of overpayment to be credited to 2014 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.

.00

12. Amount of overpayment to be refunded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.

.00

Section 5: Total Payment Due with Form 502

13. Balance of tax due from Line 4 plus the extension penalty on Line 5, if applicable . . . . . . . . . . . . . . . . . . . . . . . . 13.

.00

14. Interest charges on withholding tax from Line 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.

.00

15. Late filing penalty. Enter the greater of Line 6 or Line 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15.

.00

16. Total payment due (Add Line 13, Line 14 and Line 15) or (net of Line 3 and Line 8 or Line 3 and Lines 7

and 9) whichever applies. If an overpayment, enclose in parentheses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.

.00

I, the undersigned owner and authorized representative of the pass-through entity for which this return is made, declare under the penalties

provided by law that this return (including any accompanying schedules, statements and attachments) has been examined by me and is, to the best

of my knowledge and belief, a true, correct, and complete return, made in good faith, for the taxable year stated, pursuant to the tax laws of the

Commonwealth of Virginia. A preparer other than the authorized representative declares the same, and such declaration is based on all information

of which he or she has any knowledge.

(Signature and Phone Number of Owner or Authorized Representative)

(Title)

(Date)