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2024

Nebraska

Financial Institution

Tax Return

Included in this Booklet:

DRAFT AS OF 10/30/2024 
Form 1120NF and 

Shareholder’s Schedule.
DO NOT FILE

Electronic payment options are available. 
See instructions.

Questions?

revenue.nebraska.gov

Sign up for a FREE subscription service at the Nebraska Department 
of Revenue’s website to get email updates on your topics of interest.

800-742-7474 (NE or IA) or 402-471-5729

                                          8-403-2024

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2024 Nebraska Financial Institution Tax Return
Instructions

What’s New
Financial Institution Tax and Limitation Rate Change ( LB 754 [2023]). The financial
institution tax rate for taxable year 2024 is reduced to $.35 per $1,000 of average deposits
and the limitation amount is reduced to 2.85% of net financial income. The tax rate on
average deposits and the limitation rate is based on the highest corporate rate which was
reduced from 7.25% for 2023 to 5.84% for 2024.
Creating High Impact Economic Futures (CHIEF) Act (LB 1344). Effective January 1, 2025,
the Community Development Assistance Act (CDAA) is replaced by the CHIEF Act.
Under the CHIEF Act, individuals and entities that contribute to community betterment
organization programs or projects certified for tax credit status by the Nebraska Department
of Economic Development during a tax year are eligible for the nonrefundable credit. The
credit for contributions made by an individual is equal to 100% of the contribution. The credit
is equal to 50% of the contribution for all other contributors. Contributions must be made
after January 1, 2025. Unused credits may be carried forward for five tax years.
LB 34 Special Session. LB 34 enacted in the 2024 special session created the School District
Property Tax Relief Act. This act provides property tax relief for school district taxes directly
on the property tax statement reducing property taxes before they are paid.
For tax years beginning on or after January 1, 2024, the Form PTC will only be used to claim
a credit for community college property taxes paid.

Terms
Average Deposits. Average deposits are the total deposits accepted at the financial institution’s
Nebraska locations, plus deposits solicited from Nebraska residents that are accepted at
locations outside of Nebraska. This amount is calculated as follows:
DRAFT AS OF 10/30/2024
u Calendar-year financial institutions. The average is the total deposits held on the last
day of the preceding year and the last day of each calendar quarter within the current
year, divided by five.
u Fiscal-year financial institutions or short-period financial institutions. The average is
DO NOT FILE
the total deposits held on the last day of the preceding fiscal year, the last day of each
complete calendar quarter within the tax year, and the last day of the tax year, divided
by the number of amounts added together.
Deposits. Deposits are:
u Money placed in the custody of the financial institution for safety or convenience that
may be withdrawn at the will of the depositor, or under the rules and regulations agreed
upon by the financial institution and the depositor; and
u Money for which a certificate may be issued and that may be payable on demand, on
certain notice, or at a fixed future date or time.
Deposits do not include money placed with the trust department of any financial institution
in a fiduciary capacity. Deposits do include any money placed in the trust department with
the financial institution that is not in a fiduciary capacity.
Financial Institution. Financial institution includes any of the following entities that are
chartered or qualified to do business in Nebraska and have a business location in Nebraska.
u Bank
u Building and loan association
u Credit union, except federally-chartered
u Savings bank
u Savings and loan association
u Any subsidiary of the entities listed above

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                       A financial institution also includes a bank holding company or a financial holding company 
                     that is not chartered to do business in Nebraska, but maintains a permanent place of business 
                     in the state and actively solicits deposits from Nebraska residents for an affiliate.
                     Subsidiary. Subsidiary does not include any bank, bank holding company, financial holding 
                     company, or savings and loan association that is owned 50% or more by a mutual savings 
                     and loan association and does not actively solicit deposits from Nebraska residents.
                     Net Financial Income. Net financial income is the income of the financial institution, including 
                     its subsidiaries, after ordinary and necessary expenses, but before income taxes and discontinued 
                     operations. Income and expenses must be computed according to the requirements of the 
                     financial institution’s regulatory agencies.

 Who Must File?
                     Every financial institution, as defined above, must file a Nebraska Financial Institution 
                     Tax Return.
                     A financial institution does not file a Nebraska Corporation Income Tax Return, Form 1120N.

                     Financial institutions maintaining a permanent place of business in this state, actively soliciting 
                     deposits from residents of this state and organized as a S corporation must file a Nebraska 
                     Financial Institution Tax Return, Form 1120NF and a Nebraska S Corporation Income Tax 
                     Return, Form 1120-SN.

Important Information for All Filers
                     Period Covered by the Return. This return must be filed for the 2024 calendar year or fiscal 
                     year beginning in 2024. Contact DOR for instructions if the financial institution’s fiscal year 
DRAFTends otherASthan on a calendarOFquarter.                10/30/2024 
                     Financial institutions experiencing a short year (less than 12 months) must file a short-period 
                     return on or before the 15th day of the third month following the end of its short year. See: 
                     u Revenue Ruling 24-90-1: Financial Institution Tax - Filing Requirements of Short-
DO NOT FILE
                      Period Tax Returns; and
                     u Revenue Ruling 24-91-1: Financial Institution Tax - Average Deposits of Short-Period 
                      Tax Returns.
                     Enter All Amounts as Whole Dollars. Do not include cents on the return or schedules. Do not 
                     change the pre-printed zeros in the cents column of the Form 1120NF. Round any amount 
                     from 50 cents to 99 cents to the next higher dollar. Round any amount less than 50 cents to 
                     the next lower dollar.
           Penalties and Interest. Either or both may be imposed under the following conditions:
                     u Failure to file a return and pay tax due on or before the due date;
                     u Failure to pay the tax due on or before the due date;
                     u Failure to file an Amended Nebraska Financial Institution Tax Return to report changes 
                      made to the financial institution's amount of deposits or net financial income;
                     u Preparing or filing a fraudulent return; or
                     u Understatement of deposits or net income before taxes and discontinued operations 
                      on a financial institution tax return.
                    Filing a false or fraudulent Nebraska tax return is subject to penalty, even if the amounts 
                     reported are taken from your federal return or reports filed with state or federal regulatory 
                     agencies. Unpaid tax is subject to interest at the statutory rate of 8% from the original due 
                     date to the date the tax is paid. See Revenue Ruling 99-24-1 for applicable interest rates.
                     Reporting Changes or Corrections. Use Amended Nebraska Financial Institution Tax 
                     Return, Form 1120XNF, for the tax year corresponding to the return being amended. 

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                    NOTE: A refund of tax is only allowed when an amended return is filed within 90 days of 
          the date the tax is due or was paid, whichever is later, or within 90 days of a change made 
          by a state or federal regulatory agency.
                    When filing an amended return to reflect corrected Call Report information, attach copies of 
          the changed pages from the Call Report. When filing an amended return to report a change 
          made by a state or federal regulatory agency to the financial institution’s amount of deposits 
          or its net financial income, include a dated copy of the regulatory agency’s notice.
          Nebraska Extension of Time. No extension of time to file or pay the tax is allowed. 
          Accounting Methods. The accounting method required by state and federal regulatory agencies 
          must be used for Nebraska financial institution tax purposes. Income and expenses of a financial 
          institution must be computed according to the requirements of its regulatory agencies. 
          Multistate Financial Institutions. Financial institutions that are subject to tax in more than 
          one state must compute their tax liability based on the amount of average deposits connected 
          with the financial institution’s operations in Nebraska. These deposits equal the total deposits 
          accepted at the financial institution’s Nebraska offices, plus deposits solicited from Nebraska 
          residents that are accepted at the financial institution’s offices outside of Nebraska. The 
          financial institution’s limitation amount is computed using the portion of the net financial 
          income that is apportioned to Nebraska using property and payroll factors.

When and Where to File
          This return must be filed on or before the 15th day of the third month following the close of 
          the taxable year of the financial institution. 
          Mail the return to:
            Nebraska Department of Revenue
            PO Box 94818
            Lincoln, NE 68509-4818.
DRAFTNote: NoASextension of timeOFto file this return10/30/2024or pay the tax is allowed.

How to Complete Form 1120NF
DO NOT FILE
          Reminder for S Corporations.  Financial institutions electing to be taxed under the Internal 
          Revenue Code (IRC) as S corporations must complete the Shareholder’s Schedule (Schedule) 
          of Form 1120NF and provide each shareholder with a    Statement of Nebraska Financial 
          Institution Tax Credit, Form NFC. If an estate or trust owns shares of the financial institution, 
          a list of the beneficiaries of the estate or trust must be attached to the Schedule and each 
          beneficiary must be provided with a Form NFC. These forms are used to calculate the amount 
          of credit available to each shareholder or beneficiary, as applicable. 
           u File the Schedule with Form 1120NF. If additional lines are needed, make copies of 
             the Schedule and attach them to Form 1120NF.
           u Financial institutions electing to be taxed under the IRC as S corporations owned by 
             an S corporation holding company, and financial institutions with shares owned by an 
             estate or trust, must list the shareholders or beneficiaries, as applicable, of the holding 
             company on the Schedule.
           u Shareholders or beneficiaries, as applicable, will file the Form NFC with their individual 
             income tax returns when claiming their proportionate share of credit for the tax paid 
             by the financial institution.
          Business Classification Code. Enter the number that best describes your principal activity 
          from the following list:
            522110  Commercial bank;
            522120  Savings institution;
            522130  Credit union; or 
            522190  Other depository credit intermediation.

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Lines 1 – 5 Ending Deposits. Enter the amount of ending deposits at the preceding year-end and the
ending deposits of each calendar quarter of the financial institution’s taxable year beginning
in 2024. Refer to the chart on page 8 of these instructions as a guide to determine the ending
deposits for each period.
Line 7 Average Deposits. Divide the total deposits on line 6 by five, and enter the result on line 7.
Fiscal-year or short-period returns should compute average deposits as described in Average
Deposits on page 2 of these instructions.

Line 8 Financial Institution Tax. The financial institution must pay the lesser of the tax on average
deposits or the limitation amount. The tax is required to be paid on or before the original
due date of the return. Financial institutions have the option to file an estimated payment
voucher during the final month of the tax year.
For additional information, see the Nebraska Financial Institution Voluntary Estimated Tax
Payment, Form 1120NF-ES.
The rate of tax is the rate in effect on the first day of the financial institution’s taxable year.
For tax year 2024, the rate of tax is $.35 per $1,000 of average deposits.

Line 9 Net Income. Enter the amount of net income before income taxes and discontinued operations
of the financial institution for the taxable year beginning on or after January 1, 2024. Refer
to the chart on page 8 of these instructions to determine the appropriate line number amount
and possible adjustments to make for each reporting period necessary to arrive at the total
representing the entire taxable year. Enter this total as net income before income taxes and
discontinued operations on line 9.
Multistate Financial Institutions. Financial institutions that are subject to tax in more than
one state must compute their net income using the portion of the net financial income
that is apportioned to Nebraska using the property and payroll factors in Neb. Rev. Stat.
§§ 77-2734.12 and 77-2734.13.
Net Losses. If the financial institution has a net loss before income taxes and discontinued
DRAFToperations,ASenter -0- onOFline 9. Net losses10/30/2024cannot be carried to any other year or any other
return. Net losses cannot be used to obtain a refund for a prior or subsequent taxable year.

Line 10 Limitation Amount. For tax year 2024, the rate is 2.85% of the net financial income.
DO NOT FILE
Line 12 Community Development Assistance Act (CDAA) Credit. This nonrefundable credit is
allowable for contributions to approved projects of community betterment organizations
recognized by the Nebraska Department of Economic Development (DED). Attach the 2024
Nebraska Community Development Assistance Act Credit Computation, Form CDN, to the
Form 1120NF. Financial institutions do not need to attach a copy of the Form 1099NTC.
DOR will receive the Form 1099NTC information directly from DED. The credit must be
claimed on the tax return for the year in which the contribution was made. Any credits may
be carried forward for up to five years from the year in which the credit was allowed.

More detailed information on this credit can be obtained by contacting:
Nebraska Department of Economic Development
245 Fallbrook Blvd, Suite 002
Lincoln, NE 68521
opportunity.nebraska.gov

Darin Lubke
402-471-3116
darin.lubke@nebraska.gov

Line 13 New Markets Tax Credit (NMTC). This nonrefundable credit is allowed for an investment
in a qualified community development entity. Attach a copy of Nebraska Incentives Credit
Computation, Form 3800N, and any supporting schedules, and enter the amount from line 9
of Form 3800N. The tax credit may be claimed for the tax year that includes the applicable
credit allowance date. The credit is nonrefundable, but may be carried forward for up to five
taxable years from the year it is first allowed.
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Line 14 Nebraska Historic Tax Credit (NHTC). This nonrefundable, and in some cases, transferable
tax credit is allowed for eligible expenditures to rehabilitate, preserve, or restore qualifying
historically-significant real property. Attach a copy of the Nebraska Incentives Credit
Computation, Form 3800N, and a Nebraska Historic Tax Credit Form 3800N, Worksheet
NHTC. Enter the amount of the credits from line 10 of Form 3800N. The credits may be
carried forward until fully utilized, or until December 31, 2035, whichever occurs first.

Line 15 Affordable Housing Tax Credit (AHTC). This nonrefundable tax credit is allowed to financial
institutions in an amount not exceeding the federal Low-Income Housing Tax Credit. Enter
the amount of nonrefundable Nebraska AHTCs from line 11 of Nebraska Incentives Credit
Computation, Form 3800N. Attach a copy of Form 3800N to the Form 1120NF. Any credits
may be carried forward until fully utilized.

Line 16 Creating High Impact Economic Futures (CHIEF) Credit. This nonrefundable credit is
allowable for contributions to community betterment organization programs or projects
certified for tax credit status by the Nebraska Department of Economic Development. The
credit must be claimed on the tax return for the year in which the contribution was made.
Any credits may be carried forward for up to five years from the year in which the credit
was allowed. Contributions must be made after January 1, 2025. Contact DOR to obtain the
necessary form and other documentation requirements for claiming this credit.
More detailed information on this credit can be obtained by contacting:
Nebraska Department of Economic Development
245 Fallbrook Blvd, Suite 002
Lincoln, NE 68521
opportunity.nebraska.gov

Darin Lubke
402-471-3116
DRAFT darin.lubke@nebraska.govAS OF 10/30/2024

Line 17 Total Nonrefundable Credits. Total the credits on lines 12 through 16.
DOLine 18 NOTNebraska TaxFILEAfter Nonrefundable Credits.Subtract line 17 from line 11. If the result is less
than zero, enter -0-.
Line 19 Credit for Community College Property Taxes. This refundable credit is allowed to financial
institutions that paid Nebraska community college property taxes. To claim the credit,
taxpayers must complete and submit a Nebraska Property Tax Credit, Form PTC. Enter the
amount from line 1 of Form PTC and attach Form PTC.
S Corporations. Financial institutions electing to be taxed under the IRC as S corporations
that claim the credit amount from line 1 of Form PTC on line 25 of Form 1120-SN, enter
zero. This credit may be claimed on either Form 1120NF or Form 1120-SN, but not both.
Line 20 Nebraska Higher Blend Tax Credit (HBTC). This refundable credit is allowed to retail dealers
who sold E-15 or higher blends of ethanol gasoline from retail motor fuel sites in Nebraska.
Attach a copy of the Nebraska Incentives Credit Computation, Form 3800N. Enter the
amount from line 21 of Form 3800N. The credits may be carried forward until fully utilized.
Line 21 PTET credit. Enter the refundable income tax credit for passthrough entity tax (PTET)
paid by a partnership in which the financial institution holds an ownership interest. Attach
Schedule(s) K-1N, and an additional schedule if the credit was received from more than one
partnership.
Line 22 Voluntary Estimated Tax Payment. Enter the amount of any voluntary estimated tax payment.

Line 23 Total Refundable Credits and Payments. Total lines 19 through 22.

Line 24 Balance Due. If the amount on line 18 is greater than line 23, enter the difference as a balance
due on line 24.

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Electronic Payment. Payment of tax may be made electronically.
Financial institutions that made tax payments exceeding $5,000 in a prior year are required
to make all payments electronically.
Payment Options (Nebraska e-pay, ACH Credit, Tele-pay). Pay the amount due electronically.
It's secure, easy, and fast.
Credit Card. Secure credit card payments can be initiated through ACI Payments, Inc. at
acipayonline.com or via telephone at 800-272-9829. Eligible credit cards include American
Express, Discover, MasterCard, and VISA. A convenience fee will be charged to the credit
card you used. This fee is paid to the credit card vendor, not the State of Nebraska, and will
appear on the credit card statement separately from the tax payment.
Check or Money Order. Make check or money order payable to the “Nebraska Department
of Revenue.” Checks written to DOR may be presented for payment electronically.

Line 25 Overpayment. If the amount on line 23 is greater than line 18, enter the difference as an
overpayment on line 25.

Line 27 Amount to be Refunded. DOR recommends having any refund on line 27 directly deposited
to a bank account. See line 28 instructions below.

Lines 28a-28d Direct Deposit. To have a refund directly deposited into your checking or savings account,
enter the routing number and account number associated with the account.
u 28a. The routing number is listed first and must be nine digits.
u 28b. Indicate the type of account – checking or savings.
u 28c. The account number is listed to the right of the routing number and can be up to
17 characters.
u 28d. Box 28d is used to comply with financial institution rules regarding International
ACH Transactions (IATs). Refunds to accounts outside of the United States cannot
DRAFT AS OF 10/30/2024
be processed as direct deposits and instead, will be mailed.
Sign and Date the Tax Return. This return must be signed by an officer of the financial
institution. If another person is authorized to sign this return, there must be a power of
attorney on file with DOR or attached to the return.
DO NOT FILE
Email. By entering an email address, the taxpayer acknowledges that DOR may contact
the taxpayer by email. The taxpayer accepts any risk to confidentiality associated with this
method of communication. DOR will send all confidential information by secure email or
the State of Nebraska’s file share system. If you do not wish to be contacted by email, write
“Opt Out” on the line labeled “email address.”
Paid Preparer’s Use Only. Any person who is paid for preparing a financial institution’s return
must also sign the return as a preparer. The preparer must enter his or her Preparer Tax ID
Number (PTIN), the firm’s name, and Federal Employer ID Number (EIN).
Contact Information. For additional assistance, please contact:
Nebraska Department of Revenue
PO Box 94818
Lincoln, NE 68509-4818
800-742-7474 (Nebraska and Iowa) or 402-471-5729
revenue.nebraska.gov

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                                               Call Report References*
                                     • For use in completing lines 1-5 and line 9 of Form 1120NF
                                                             Reports and Line Numbers
  Type of Financial                                                                              Line 9:
                                                 Lines 1-5:
  Institution                                                                      Net Income Before Income Taxes
                                              Ending Deposits
                                                                                   and Discontinued Operations 
 Banks and Savings Associations Form FFIEC 031                                    Form FFIEC 031
 with Domestic and Foreign Offices   Consolidated Report of Condition              Consolidated Report of Income
                                     Schedule RC-Balance Sheet                     Schedule RI-Income Statement
                                     Liabilities (Page RC-2)                       Line 8 (Page RI-2)
                                     Line 13 Deposits                              Income (loss) before applicable income  
                                Enter the total of lines 13.a. and 13.b.             taxes and discontinued operations
                                                                                  Enter line 8.c.
                                                                                  FOR THE ENTIRE TAXABLE YEAR 
 Banks and Savings Associations Form FFIEC 041                                    Form FFIEC 041
 with Domestic Offices Only          Consolidated Report of Condition              Consolidated Report of Income
                                     Schedule RC-Balance Sheet                     Schedule RI-Income Statement
                                     Liabilities (Page RC-1)                       Line 8 (Page RI-2)
                                     Line 13 Deposits                              Income (loss) before applicable income  
                                Enter line 13.a.                                     taxes and discontinued operations
                                                                                  Enter line 8.c.
                                                                                  FOR THE ENTIRE TAXABLE YEAR 
 Credit Unions                  National Credit Union Administration              National Credit Union Administration
                                     Form NCUA 5300                                Form NCUA 5300
                                     Statement of Financial Condition              Statement of Income and Expense
                                                                                   (Page 5):
                                     Liabilities, Shares/Deposits (Page 3)         Line 35 Net income
                                     Line 7 Total Shares and Deposits             Less:
                                Enter line 7.                                      Line 15 Gain (loss) on Equity and Trading  
                                                                                     Debt Securities
                                                                                   Line 16 Gain (loss) on all other 
DRAFT                                 AS OF 10/30/2024                               Investments or change in fair value of    
                                                                                     hedged items
                                                                                   Line 17 Gain (loss) on Derivatives 
                                                                                   Line 18 Gain (loss) on Disposition of         
                                                                                     Fixed Assets
DO             NOT                    FILE                                         Line 21 Gain from Bargain Purchase            
                                                                                     (Merger)
                                                                                   Line 22 Other Non-interest Income 
                                                                                  Enter line 35 minus lines 15 through 18, 21,   
                                                                                  and 22.
                                                                                  FOR THE ENTIRE TAXABLE YEAR
                                                                                        
* This chart references the call reports available as of March 31, 2024. If these call reports are modified and the line numbers do not remain constant, please use this 
chart as a guide to report the financial institution’s deposits, estimated deposits, estimated net income before income taxes and discontinued operations, and actual 
net income before income taxes and discontinued operations in a consistent manner.

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                                     Nebraska Financial Institution Tax Return                                                             FORM 1120NF
                                 for the calendar year January 1, 2024 through December 31, 2024 or other taxable year
                                        beginning                     , 2024 and ending                   , 20
                                                                                                                                           2024
  Name of Financial Institution                                                                 PLEASE DO NOT WRITE IN THIS SPACE

  Street or Other Mailing Address

  City                                                 State                   ZIP Code 

  Business Classification Code                         Federal ID Number                                   Nebraska ID Number              

 Type of financial institution – check applicable box:        
 (1)   Bank                      (2) Savings Association                  (3)  Credit Union                (4)  Other
                                 • Enter dollar amounts in ones, not in thousands (for example, 14 million must be written as 14,000,000).
 1    Preceding year-end deposits ...............             1                                            00
 2    First quarter ending deposits ...............           2                                            00
 3    Second quarter ending deposits ............             3                                            00
 4    Third quarter ending deposits ..............            4                                            00
 5    Fourth quarter ending deposits .............            5                                            00
 6    Total deposits (total of lines 1 through 5) ....................................                         6                                         00
 7    Average deposits (line 6 divided by 5) (fiscal-year taxpayers, see instructions) ......                  7                                         00
 8    Financial institution tax (line 7 multiplied by .00035) ...........................                      8                                         00
 9    Net income before income taxes and discontinued operations (enter -0- if the
   financial institution has a net loss) .........................................                             9                                         00
 10   Limitation amount (line 9 multiplied by .0285) ................................                          10                                        00
 11   Enter line 8 or line 10, whichever is less ....................................                          11                                        00
 12   Community Development Assistance Act (CDAA) credit (attach Form CDN) ........                            12                                        00
 13   New Markets Tax Credit (NMTC) (attach Form 3800N)  ........................  13                                                                    00
 14   Nebraska Historic Tax Credit (NHTC) (attach Form 3800N) .....................                            14                                        00 
 15   Affordable Housing Tax Credit (AHTC) (attach Form 3800N)                  ...................  15                                                  00
16  Creating High Impact Economic Futures (CHIEF) Credit (see instructions)  .........  16
17  Total nonrefundable credits ..............................................  17                                                                       00
 18 NebraskaDRAFTtax after nonrefundable creditsAS ................................... OF18 10/30/202400
 19   Credit for community college property taxes (attach Form PTC)  .................                         19                                        00 
 20   Nebraska Higher Blend Tax Credit (HBTC) (attach Form 3800N)   ................                           20                                        00 
21  PTET credit (attach Schedule(s) K-1N) ......  
      a Name: _____________________________ 
      b Nebraska ID Number: _________________ DO NOT FILE
      c Amount: $___________________________
   (Attach a schedule if the credit was received from more than one partnership.) . .....                      21                                        00
22  Voluntary estimated tax payment (if any) ...................................                               22                                        00
   23Total refundable credits and payments (total of lines 19 through 22)   .............                      23                                        00
 24   Balance due (when line 18 is greater than line 23)
         Check this box if payment is made electronically  .......................                             24                                        00
   25Overpayment (when line 23 is greater than line 18)  ...........................                           25                                        00
   26Amount on line 25 you want CREDITED to 2025 voluntary estimated tax ..........                            26                                        00
   27Amount to be REFUNDED (line 25 minus line 26). Complete lines 28a, 28b, and
   28c to receive your refund electronically ....................................                              27                                        00
28a Routing Number                                                                          28b Type of Account      1 = Checking          2 = Savings
28c Account Number
28d    Check this box if this refund will go to a bank account outside the United States.
           Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements and to the best of my knowledge and belief, it is correct and complete.
   sign
            Authorized Signature                             Date                           Email Address
   here
                                                             (    )
            Title                                            Daytime Phone 
       paid
preparer’s  Preparer’s Signature                             Date                           Preparer’s PTIN
 use only
                                                                                                                                           (    )
            Firm’s Name (or yours if self-employed), Address, and ZIP Code                  EIN                                            Daytime Phone 
                    This return is due on or before the 15th day of the third month following the taxable year-end.
                                                       No extension of time to file or pay will be granted.
                                     Mail this return and remit payment (electronically, if required) to:
                                 Nebraska Department of Revenue, PO Box 94818, Lincoln, NE 68509-4818.
                                     revenue.nebraska.gov, 800-742-7474 (NE and IA), 402-471-5729                                                8-403-2024

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