Form Fae 172 - Quarterly Franchise, Excise Tax Declaration
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3R0011301
TENNESSEE DEPARTMENT OF REVENUE
QUARTERLY FRANCHISE, EXCISE TAX DECLARATION
Account No.
FAE
Beginning
Taxable
Year
Each taxpayer having a combined franchise
172
Ending
and excise tax liability of $5,000 or more for the
current tax year must make four quarterly es-
timated tax payments. The payments are due
on the 15th day of the fourth, sixth, and ninth
months of the current year and the first month
of the succeeding year.
TAXPAYER NAME AND MAILING ADDRESS
Make your check payable to the Tennessee
NAME ___________________________________________________________________
Department of Revenue and mail to:
BOX (STREET) ____________________________________________________________
Tennessee Department of Revenue
Andrew Jackson State Office Building
CITY ____________________________________________________________________
500 Deaderick Street
Nashville, TN 37242
STATE ________________
ZIP __________________________
For assistance, you may call in-state toll free
1-800-342-1003 or (615) 253-0600.
REMINDERS
1. Please read instructions on reverse side before preparing worksheet.
2. Use the prenumbered vouchers and envelopes provided by the Department of Revenue.
3. Enter the amount from Line 4 of the worksheet to the "Amount of Payment" field on the voucher.
4. If Line 4 of the worksheet is zero, please do not file the voucher.
ROUND TO NEAREST DOLLAR
00
1. Estimated Franchise, Excise tax liability .................................................................................
______________________
00
2. Less: Franchise, Excise Tax Credits and prior year overpayments .........................................
______________________
00
3. Net Estimated Franchise, Excise tax liability ...........................................................................
______________________
00
4. Estimated payment (one fourth of Line 3) .................................................................................
______________________
KEEP UPPER PORTION FOR YOUR RECORDS-RETURN COPY BELOW
1
TENNESSEE DEPARTMENT OF REVENUE
Due Date:
QUARTERLY FRANCHISE, EXCISE TAX DECLARATION
FAE
If your account number is not preprinted or unknown, enter federal identification or social
BEGINNING
ENDING
.
security number
Taxable
172
Year
ACCOUNT NUMBER
(FEIN/
SSN)
AMOUNT OF
00
PAYMENT
FOR OFFICE
USE ONLY
INTERNET (1-07)
RV-R0011301
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