Form M4x - Amended Franchise Tax Return/claim For Refund - 2017 Page 2
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72017 M4X, Page 2
*174921*
Name of Corporation/Designated Filer
FEIN
Minnesota Tax ID
A
B
C
As Previously Reported
Net Change
Corrected Amounts
22 Enterprise Zone Credit (see instructions) . . . . . . . . . . . . . . . . .
22
23 Historic Structure Rehabilitation Credit . . . . . . . . . . . . . . . . . . . .
23
24
24 Greater Minnesota Internship Credit . . . . . . . . . . . . . . . . . . . .
25 Estimated tax and/or extension payments . . . . . . . . . . . . . . .
25
26 Amount due from original Form M4, line 11 (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26
27 Total credits and tax paid (add lines 22C through 25C and line 26) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
27
28 Refund amount from original Form M4, line 16 (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
28
29 Subtract line 28 from line 27 (if result is less than zero, enter the negative amount) . . . . . . . . . . . . . . . .
29
30 Amount from line 21C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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31 Tax you owe. If line 30 is more than line 29, subtract line 29 from line 30
(if line 29 is a negative amount, see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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32 If you failed to timely report federal changes or the IRS assessed a penalty (see instructions) . . . . . . . .
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33 Add line 31 and line 32 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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34 Interest (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
34
35 AMOUNT DUE (add lines 33 and 34). Skip line 36 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
35
Electronic (see instructions)
Check (see instructions)
Check payment method:
36 REFUND. If line 29 is more than line 30, subtract line 30 from line 29 . . . . . . . . . . . . . . . . . . . . . . . . . . .
36
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
return with the
Print name of person to contact within corporation to discuss this return
Title
Daytime Phone
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 55145-1255.
9995
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