Schedule Rt-1 - Statement Of Disallowed Related Entity Expenses - 2012
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1Schedule
RT-1
Statement of Disallowed
Related Entity Expenses
2012
File with Wisconsin Form 1, 1NPR, 2, 3, 4, 4T, 5, or 5S
Wisconsin Department
of Revenue
Read instructions before filling in this schedule
Part I: To Be Completed by Entity Which Paid, Accrued, or Incurred the Expense
Complete the information below and provide it to the related entity to which you paid, accrued, or
incurred the disallowed expense:
A. Identifying Information for Entity Which Paid, Accrued, or Incurred the Expense
Taxpayer Name:
Taxpayer Identification Number (FEIN or SSN):
Type of Taxpayer
(check one)
Corporation
Individual
:
Tax-Option (S) Corporation
Fiduciary
Partnership
Other (explain)
B. Identifying Information for Entity to Which the Corresponding Income Was Reported
Taxpayer Name:
Taxpayer Identification Number (FEIN or SSN):
C. Tax Year for Which Expenses Were Disallowed (Tax year of taxpayer in item A. above)
Taxable Year Beginning
and Ending
D. Amount of Expense Disallowed
1 Disallowed Interest Expense . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2 Disallowed Rent Expense . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
3 Disallowed Intangible Expense . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4 Disallowed Management Fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
5 Total of lines 1 through 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Part II: To Be Completed by Entity Named in Part I, Item B.
Complete item A. below. Assuming you included the income in your Wisconsin income, you may claim a
subtraction modification corresponding to the expenses disallowed in Part I, item D. for the taxable year
that includes the ending date of the period stated in Part I, item C. To substantiate the subtraction modi-
fication, you must file this schedule with your Wisconsin return.
A. Reporting of Income Eligible for Subtraction Modification
Specify the line(s) of your pro forma federal income tax return where you reported the income eligible
for the subtraction modification for the year you are eligible to claim the subtraction:
IC-076
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