Form 355s - S Corporation Excise Return - 2012

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File pg. 1
FOR PRIVACY ACT NOTICE,
PRINT IN BLACK INK
SEE INSTRUCTIONS.
Calendar year filers enter 01-01-2012 and 12-31-2012 below. Fiscal year filers enter appropriate dates.
Tax year beginning 3
Tax year ending 3
Form 355S
S Corporation Excise Return
2012
FEDERAL IDENTIFICATION NUMBER (FID)
NAME OF CORPORATION
PRINCIPAL BUSINESS ADDRESS
CITY/TOWN/POST OFFICE
STATE
ZIP + 4
PRINCIPAL BUSINESS ADDRESS IN MASSACHUSETTS (IF DIFFERENT)
CITY/TOWN/POST OFFICE
STATE
ZIP + 4
Are you a member of a lower-tier entity? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
1
Is the corporation incorporated within Massachusetts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
3
2
Type of corporation (select one, if applicable; enclose Form F-2) . . . . . . . . . . . . . . . .
Section 38 manufacturer
Mutual fund service
3
3
Type of corporation (select one, if applicable). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
R&D
Classified mfg
3
4
Is the corporation filing a Massachusetts unitary return? (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
3
5
If the answer to question 4 is Yes, does the corporation’s tax year end in a different month than the 355U?. . . . . . . . . . . . .
Yes
No
3
6
Is the corporation the parent of another corporation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
7
Is the corporation requesting alternative apportionment (enclose Form AA-1)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
3
8
Is this a final Massachusetts return?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
3
9
Principal business code (from U.S. return) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 9
10
FID of principal reporting corporation (if answer to line 4 is Yes). . . . . . . . . . . . . . . . . . . . . . . . 3 10
11
Average number of employees in Massachusetts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
12
Average number of employees worldwide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
13
Date of charter in Massachusetts or first date of business in Massachusetts . . . . . . . . . . . . . . . . . . . . . . . . . 13
14
Last year audited by IRS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 14
15
Have adjustments been reported to Massachusetts? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
16
Is the corporation deducting intangible or interest expenses paid to a related entity? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
3
17
Is the taxpayer enclosing a Taxpayer Disclosure Statement? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
3
18
Is the taxpayer claiming exemption from the income measure of the excise pursuant to PL 86-272? . . . . . . . . . . . . . . . . . .
Yes
No
3
SIGN HERE. Under penalties of perjury, I declare that to the best of my knowledge and belief this return and enclosures are true, correct and complete.
Signature of appropriate officer (see instructions)
Date
Print paid preparer’s name
Preparer’s SSN
or PTIN
3
/
/
Title
Date
Paid preparer’s phone
Paid preparer’s
(
)
EIN
3
/
/
Are you signing as an authorized delegate of the appropriate
Paid preparer’s signature
Date
Fill in if self-employed
corporate officer?
(enclose Form M-2848)
No
/
/
Mail to: Massachusetts Department of Revenue, PO Box 7025, Boston, MA 02204.

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