2022                           FORM 200-C                                                               Page 1

                               DELAWARE COMPOSITE
                               PERSONAL INCOME TAX RETURN                                         Reset                                                       Print Form

                                                                                                  DO NOT WRITE OR STAPLE IN THIS AREA
FISCAL YEAR                        TO

 CHECK APPLICABLE BOX:         INITIAL RETURN      FINAL RETURN                            AMENDED RETURN
LIST NUMBER OF NON-RESIDENT PARTNERS/SHAREHOLDERS:
NAME OF BUSINESS                                                                         EMPLOYER IDENTIFICATION OR SOCIAL SECURITY NUMBER

ADDRESS

CITY                                                                  STATE               ZIP CODE

DELAWARE ADDRESS (IF DIFFERENT)

CITY                                                                  STATE              ZIP CODE

DATE OF INCORPORATION                         STATE OF INCORPORATION        NATURE OF BUSINESS

1. DELAWARE SOURCED INCOME (NON-RESIDENTS ONLY)........................................................................................                                   1.

2. TAX LIABILITY (MULTIPLY LINE 1 BY .0660 ).................................................................................................................             2.

3. NON REFUNDABLE CREDITS (MUST ATTACH FORM PIT-CRS).................................................................................  .                                  3.

4. BALANCE (SUBTRACT LINE 3 FROM LINE 2. CANNOT BE LESS THAN ZERO)........................................................                                                4.

5. ESTIMATED TAXES PAID (INCLUDE REAL ESTATE ESTIMATED TAXES PAID ON THIS LINE).................................                                                          5.

6. IF LINE 5 IS LESS THAN LINE 4, SUBTRACT LINE 5 FROM LINE 4 AND ENTER HERE.................... PAY IN FULL>                                                             6.

7. IF LINE 4 IS LESS THAN LINE 5, SUBTRACT LINE 4 FROM LINE 5 AND ENTER HERE.......................... REFUND>                                                            7.

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 TRUE, CORRECT, AND COMPLETE. IF PREPARED BY A PERSON 
OTHER THAN THE TAXPAYER, HIS DECLARATION IS BASED ON ALL INFORMATION OF WHICH HE HAS ANY KNOWLEDGE.

 SIGNATURE OF AUTHORIZED OFFICER                                                  TITLE                                                                       DATE

 SIGNATURE OF PREPARER                        PREPARER’S EIN OR SSN                       PREPARER’S PHONE                                                    DATE

 STREET ADDRESS OF PREPARER                                                               CITY            STATE                                                   ZIP

       MAKE CHECK PAYABLE AND MAIL TO: DELAWARE DIVISION OF REVENUE, P.O. BOX 508, WILMINGTON, DE 19899-0508

       (Rev 0 /4 2022)                                                                   *DF21322019999*
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