Form Ri-1040c - Composite Income Tax(Return State Of Rhode Island And Providence Plantations- 2014 Page 2

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State of Rhode Island and Providence Plantations

2014 Form RI-1040C

14102499990102

Composite Income Tax Return

Name

Federal employer identification number

SECTION C: APPORTIONMENT

Column A

Column B

AVERAGE NET BOOK VALUE

Rhode Island

Everywhere

Inventory............................................................................................................................

25a

Depreciable assets............................................................................................................

25b

25c

Land...................................................................................................................................

25d

Rent (8 times annual net rental rate).................................................................................

Total. Add lines 25a, 25b, 25c and 25d.............................................................................

25e

_ . _ _ _ _

Ratio in Rhode Island, line 25e, Column A divided by line 25e, Column B.

Calculate to four (4) decimal

places......

25f

RECEIPTS

Gross receipts..........................................

26a

{

Rhode Island Sales.............................................

Sales Under 44-11-14(a)(2)(i)(B)........................

26b

Dividends...........................................................................................................................

26c

Interest..............................................................................................................................

Rents.................................................................................................................................

26d

Royalties............................................................................................................................

26e

Net capital gains................................................................................................................ 26f

Ordinary income................................................................................................................

26g

26h

Other income.....................................................................................................................

26i

Income exempt from federal taxation................................................................................

Total. Add lines 26a, 26b, 26c, 26d, 26e, 26f, 26g, 26h and 26i.......................................

26j

_ . _ _ _ _

Ratio in Rhode Island, line 26j, Column A divided by line 26j, Column B.

Calculate to four (4) decimal

places.........

26k

SALARIES

Salaries and wages paid or incurred.................................................................................

27a

_ . _ _ _ _

Ratio in Rhode Island, line 27a, Column A divided by line 27a, Column B.

Calculate to four (4) decimal

places......

27b

RATIO

_ . _ _ _ _

Total of Rhode Island ratios shown on lines 25f, 26k and 27b.....................................................................................

_ . _ _ _ _

Apportionment Ratio. Divide line 28 by the number 3 or the number of ratios used. Enter here and on pg 1, Sect A, line 7

SECTION D: QUALIFIED ELECTING MEMBER INFORMATION

If needed, attach additional schedules.

RI S

RI I

AME

DDRESS

OURCE

NCOME

OCIAL

ECURITY

UMBER

Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and

belief, it is true, accurate and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

Authorized officer signature

Print name

Date

Telephone number

Paid preparer signature

Print name

Date

Telephone number

Paid preparer address

City, town or post office

State

ZIP Code