Form 1120b-Me - Maine Franchise Tax Return For Financial Institutions - 2012 Page 6
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92012
MAINE REVENUE SERVICES
MAINE FRANCHISE TAX RETURN
99
FORM 1120B-ME
FOR FINANCIAL INSTITUTIONS
*1208410*
01/01/12
12/31/12
to
For tax period
or
to
CHECK APPLICABLE BOXES: (1)
Initial return
(2)
Final return
(3)
Change of name/address
Check here if an amended return:
Name
Federal Employer ID Number
Address
Business Code
State of
Inc.
City
State
ZIP Code
Contact Person First Name
Contact Person Last Name
Telephone Number
Check here and enclose Form CRB if this is a combined return:
Parent Company Federal ID Number
Principal Place of Activity in Maine
City Where Records are Maintained
State
Maine Tax Computation
1. MAINE NET INCOME:
a.
NET INCOME PER BOOKS ( from federal Form 1120, 1120S or 1065) ........ 1a
.00
.00
b.
MAINE NET INCOME (from line 1a above or page 2, Schedule A, line 13) .....1b
ASSETS:
2.
.00
a.
TOTAL END-OF-YEAR ASSETS (from federal Form 1120, 1120S ..................2a
or 1065)
.00
b.
MAINE ASSETS (from line 2a above or page 2, Schedule A, line 15) .............2b
TAX:
3.
Select a rate option (see instructions)
OPTION 1
OPTION 2
.00
a.
TAX ON MAINE NET INCOME ........................................................................ 3a
Leave this line blank if option 2 is elected.
.00
b.
TAX ON MAINE ASSETS ..................................................................................3b
.00
c.
TOTAL TAX (add lines 3a and 3b) .....................................................................3c
PREPAYMENTS AND CREDITS:
4.
.00
a.
ESTIMATED TAX PAID AND DEPOSIT WITH EXTENSION PAYMENT VOUCHER .....4a
.00
b.
WITHHOLDING .................................................................................................4b
.00
c.
PAID WITH ORIGINAL RETURN (if this is an amended return) ........................4c
.00
d.
NET OPERATING LOSS CREDIT (see instructions) .........................................4d
.00
e.
TAX CREDITS (see instructions) .......................................................................4e
.00
f.
TOTAL PREPAYMENTS AND CREDITS (add lines 4a through 4e) .................. 4f
Rev. 9/12
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