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TENNESSEE DEPARTMENT OF REVENUE RV-R0012001 (12/23)
Franchise and Excise Financial Institution and
Captive Real Estate Investment Trust Tax Return
Tax Year Beginning Account Number Check all that apply:
FAE
174 a) Amended return
Tax Year Ending FEIN
b) Final return
NAICS SOS Control Number
c) Captive REIT not owned by a bank, bank
holding company or public REIT
d) Taxpayer has made an election to
Legal Name calculate net worth per the provisions of
Tenn. Code Ann. §67-4-2103(g)-(i)
e) Taxpayer has filed the prescribed form
to revoke its election made per Tenn.
Mailing Address Code Ann. §67-4-2103(g)-(i)
f) Annualized income installment method
for quarterly estimates election
City g) Taxpayer has filed for federal extension
h) Franchise tax triple weighted sales
election (Captive REIT)
State ZIP Code
Date Tennessee operations began (see instructions)
Schedule A ‑ Computation of Franchise Tax Round to the nearest dollar
1. Total net worth from Schedule F1, Line 3 or Schedule F2, Line 3 and Schedule F .................................................. (1) ______________________________________
2. Total real and tangible personal property from Schedule G, Line 15 ........................................................................ (2) ______________________________________
3. Franchise tax (25¢ per $100 or major fraction thereof on the greater of Lines 1 or 2; minimum $100) .............(3) ______________________________________
Schedule B ‑ Computation of Excise Tax
4. Income subject to excise tax from Schedule J, Line 41 ................................................................................................ (4) ______________________________________
5. Excise tax (6.5% of Line 4) .............................................................................................................................................. (5) ______________________________________
6. Recapture of tax credit (from Schedule T, Line 13) ...................................................................................................... (6) ______________________________________
7. Total excise tax due (add Lines 5 and 6) ....................................................................................................................... (7) ______________________________________
Schedule C ‑ Computation of Total Tax Due or Overpayment
8. Total franchise and excise taxes (add Lines 3 and 7) ............................................................. (8) ______________________________________
9. Total credit from Schedule D, Line 9 (cannot exceed Line 8) ................................................ (9) ______________________________________
10. Net tax (subtract Line 9 from Line 8; if Line 9 exceeds Line 8, enter zero here) ................ (10) ______________________________________
11. Total payments from Schedule E, Line 7 ................................................................................. (11) ______________________________________
12. Penalty (see instructions) ......................................................................................................... (12) ______________________________________
13. Interest (see instructions) .............................................................................................................................................(13) ______________________________________
14. Penalty on estimated franchise and excise tax payments .......................................................................................(14) ______________________________________
15. Interest on estimated franchise and excise tax payments ......................................................................................(15) ______________________________________
16. Total amount due (overpaid) (add Lines 10, 12, 13, 14, and 15, subtract Line 11) ................................................(16) ______________________________________
If overpayment reported on Line 16, complete A and/or B below:
A. Credit to next year’s tax $ ______________________________________ B. Refund $ _______________________________
Under penalties of perjury, I declare that I have examined this report, and to the best of my knowledge
Power of Attorney - Check YES if this taxpayer's and belief, it is true, correct, and complete.
signature certifies that this tax preparer has
the authority to execute this form on behalf Taxpayer's Signature Date Title
of the taxpayer and is authorized to receive
and inspect confidential tax information Tax Preparer's Signature Preparer's PTIN Date Telephone
and to perform any and all acts relating to
respective tax matters. Preparer's Address City State ZIP Code
YES Preparer's Email Address
FOR OFFICE USE ONLY
