Form M4x - Amended Franchise Tax Return/claim For Refund - 2015 Page 2
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7M4X page 2
15492
2015 Amended Franchise Tax Return/Claim for Refund
(continued)
Name of Corporation/Designated Filer
FEIN
Minnesota Tax ID
A
B
C
As Previously Reported
Net Change
Corrected Amounts
23
23 Enterprise Zone Credit (see instructions) . . . . . . . . . . . . . . . .
24
24 JOBZ Jobs Credit (see instructions) . . . . . . . . . . . . . . . . . . . . . .
25
25 Historic Structure Rehabilitation Credit . . . . . . . . . . . . . . . . . .
26
26 Greater Minnesota Internship Credit . . . . . . . . . . . . . . . . . . .
27
27 Estimated tax and/or extension payments . . . . . . . . . . . . . .
28 Amount due from original Form M4, line 12 (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
28
29
29 Total credits and tax paid (add lines 23C through 27C and line 28) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
30 Refund amount from original Form M4, line 17 (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
30
31
31 Subtract line 30 from line 29 (if result is less than zero, enter the negative amount) . . . . . . . . . . . . . . .
32 Amount from line 22C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
32
33 Tax you owe. If line 32 is more than line 31, subtract line 31 from line 32
33
(if line 31 is a negative amount, see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
34
34 If you failed to timely report federal changes or the IRS assessed a penalty (see instructions) . . . . . . .
35 Add line 33 and line 34 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
35
36
36 Interest (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
37 AMOUNT DUE (add lines 35 and 36) . Skip line 38 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
37
Check payment method:
Electronic (see instructions)
Check (see instructions)
38 REFUND . If line 31 is more than line 32, subtract line 32 from line 31 . . . . . . . . . . . . . . . . . . . . . . . . . .
38
If you have a refund, you must enter your banking information below.
Account type:
Routing number
Account number
(use an account not associated with any foreign accounts)
Checking
Savings
I declare that this return is correct and complete to the best of my knowledge and belief.
Authorized Signature
Title
Date
Daytime Phone
I authorize
the Minnesota
Department
Signature of Preparer
PTIN
Date
Daytime Phone
of Revenue to
discuss this tax
Print name of person to contact within corporation to discuss this return
Title
Daytime Phone
return with the
preparer .
Explain net changes on the following page and show computations in detail. Enclose the list of changes, amended schedules and
amended federal Form 1120X, if any .
Mail to: Minnesota Revenue, Mail Station 1255, St . Paul, MN 55146-1255 .
9995
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