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 05              2016                                                                           FORM 200-C                                                                                                                                  Page 1                                                              05 
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 07                                                                                 DELAWARE COMPOSITE                                                                                                                                                                                                          07 
 08                                                         PERSONAL INCOME TAX RETURN                                                                                                                                                                                                                          08 
 09                                                                                                                                                                                                                                                                                                             09 
 10                                                                                                                                                                                                 DO NOT WRITE OR STAPLE IN THIS AREA                                                                         10 
 11         FISCALYEAR                                                              TO                                                                                                                                                                                                                          11 
 12                                                                                                                                                                                                                                                                                                             12 
 13         CHECKAPPLICABLEBOX:                                                      INITIALRETURN                                  FINALRETURN                                                       AMENDEDRETURN                                                                                             13 
 14         LISTNUMBEROFNON-RESIDENTPARTNERS/SHAREHOLDERS:                                                                                                                                                                                                                                                      14 
 15         NAME OF BUSINESS                                                                                                                                                        EMPLOYER IDENTIFICATION OR SOCIAL SECURITY NUMBER                                                                           15 
 16                                                                                                                                                                                                                                                                                                             16 
 17 ADDRESS                                                                                                                                                                                                                                                                                                     17 
 18                                                                                                                                                                                                                                                                                                             18 
 19         CITY                                                                                                                    STATE                                           ZIP CODE                                                                                                                    19 
 20                                                                                                                                                                                                                                                                                                             20 
 21         DELAWARE ADDRESS (IF DIFFERENT)                                                                                                                                                                                                                                                                     21 
 22                                                                                                                                                                                                                                                                                                             22 
 23         CITY                                                                                                                    STATE                                           ZIP CODE                                                                                                                    23 
 24                                                                                                                                                                                                                                                                                                             24 
 25                                                                                                                                                                                                                                                                                                             25 
 26 DATE OF INCORPORATION                                                                       STATE OF INCORPORATION                                     NATUREOFBUSINESS                                                                                                                                     26 
 27                                                                                                                                                                                                                                                                                                             27 
 28                                                                                                                                                                                                                                                                                                             28 
 29                                                                                                                                                                                                                                                                                                             29 
 30 1. DELAWARESOURCEDINCOME(NON-RESIDENTSONLY)...............................................................................................                                                                                                                                                              1   30 
 31                                                                                                                                                                                                                                                                                                             31 
 32 2. TAXLIABILITY(MULTIPLYLINE1BY.0660   )......................................................................................................................                                                                                                                                          2.  32 
 33                                                                                                                                                                                                                                                                                                             33 
 34 3. NONREFUNDABLECREDITS(MUSTATTACHFORM700).................................................................................................                                                                                                                                                             3.  34 
 35                                                                                                                                                                                                                                                                                                             35 
 36 4.      BALANCE(SUBTRACTLINE3FROMLINE2.  CANNOTBELESSTHANZERO)....................................................................                                                                                                                                                                      4.  36 
 37                                                                                                                                                                                                                                                                                                             37 
 38 5. ESTIMATEDTAXESPAID(INCLUDE REAL ESTATE ESTIMATED TAXES PAID ON THIS LINE)....................................................                                                                                                                                                                        5.  38 
 39                                                                                                                                                                                                                                                                                                             39 
 40 6. IFLINE5ISLESSTHANLINE4,SUBTRACTLINE5FROMLINE4ANDENTERHERE...................................... PAYINFULL>                                                                                                                                                                                           6.  40 
 41                                                                                                                                                                                                                                                                                                             41 
 42 7. IFLINE4ISLESSTHANLINE5,SUBTRACTLINE4FROMLINE5ANDENTERHERE............................................REFUND>                                                                                                                                                                                         7.  42 
 43                                                                                                                                                                                                                                                                                                             43 
 44                                                                                                                                                                                                                                                                                                             44 
 45 UNDERPENALTIESOFPERJURY,IDECLARETHATIHAVEEXAMINEDTHISRETURN,INCLUDINGACCOMPANYINGSCHEDULESANDSTATEMENTS,ANDTO                                                                                                                                                                                               45 
 46 THEBESTOFMYKNOWLEDGEANDBELIEFITISTRUE,CORRECT,ANDCOMPLETE.  IFPREPAREDBYAPERSONOTHERTHANTHETAXPAYER,HIS                                                                                                                                                                                                     46 
 47 DECLARATIONISBASEDONALLINFORMATIONOFWHICHHEHASANYKNOWLEDGE.                                                                                                                                                                                                                                                 47 
 48                                                                                                                                                                                                                                                                                                             48 
 49                                                                                                                                                                                                                                                                                                             49 
 50         SIGNATURE OF AUTHORIZED OFFICER                                                                                                                TITLE                                                                                                                    DATE                        50 
 51                                                                                                                                                                                                                                                                                                             51 
 52                                                                                                                                                                                                                                                                                                             52 
 53                                                                                                                                                                                                                                                                                                             53 
 54         SIGNATURE OF PREPARER                                                                                                   PREPARER’S EIN OR SSN                                           PREPARER’S PHONE                                                                DATE                        54 
 55                                                                                                                                                                                                                                                                                                             55 
 56                                                                                                                                                                                                                                                                                                             56 
 57         STREET ADDRESS OF PREPARER                                                                                                                                              CITY                                                    STATE                                   ZIP                         57 
 58                                                                                                                                                                                                                                                                                                             58 
 59                                                                                                                                                                                                                                                                                                             59 
 60              MAKECHECKPAYABLEANDMAILTO:  DELAWAREDIVISIONOFREVENUE,P.O.BOX508,WILMINGTON,DE  19899-0508                                                                                                                                                                                                     60 
 61                                                                                                                                                                                                                                                                                                             61 
 62                                                                                                                                                                                 *DF21316019999*                                                                                                             62 
 63              (Rev. 11/02/15)                                                                                                                                                                    DF21316019999                                                                                               63 
 64                                                                                                                                                                                                                                                                                                             64 
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                      INSTRUCTIONS FOR 201  COMPOSITE6                                                                                                     PERSONAL INCOME TAX RETURN                                                                                                                        06 
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 07                                                                                                                                                                                                                                                                                                          07 
 08 The Delaware Division of Revenue will accept a composite                                                                                               · No net operating losses will be allowed.                                                                                                        08 
 09 return of  qualifying  non-resident shareholders  of  an  S                                                                                            · Any refund or overpayment of income taxes made on                                                                                               09 
 10 corporation  (or  of  a  limited liability company which is                                                                                            a composite basis must be remitted to the  organization                                                                                           10 
 11 treated as a partnership) or of qualifying non-resident                                                                                                for distribution to the members.                                                                                                                  11 
    individual  partners  of  a  partnership  if  all  conditions 
 12                                                                                                                                                                                                                                                                                                          12 
 13 specified below are met:                                                                                                                               A  composite return  may not be changed  or  corrected                                                                                            13 
 14                                                                                                                                                        except  by  an  amended  composite return filed  by  the                                                                                          14 
 15 · Individuals included in the composite return must be                                                                                                 entity.    All  S  Corp  estimated  payments  must  be  made                                                                                      15 
    non-residents of the State of Delaware for the full  taxable
                                                                                                                                                           with  S  Corp  coupons  (1100P)  or  returns  (1100S),  not 
 16 year.                                                                                                                                                                                                                                                                                                    16 
                                                                                                                                                           the  Composite  return  filing.  Partnerships  must  file  their 
 17 ·Individuals included in the composite return must  have                                                                                                                                                                                                                                                 17 
 18 no income (including spouse's) from sources  within the                                                                                                estimated taxes with 200-ES coupons.                                                                                                              18 
 19 state other than his or her distributive share  of corporate                                                                                                                                                                                                                                             19 
 20 or partnership income whose source is  within Delaware.                                                                                                A copy of Form 5403, Real Estate Tax Return, must be                                                                                              20 
 21 · All individuals included in the composite return must                                                                                                attached to the composite return if any real estate tax                                                                                           21 
 22 have the same tax year for income tax purposes.                                                                                                        payments  were  declared  and  paid  on  behalf  of  any                                                                                          22 
 23                                                                                                                                                        qualifying  non-resident  stockholders  or  qualifying                                                                                            23 
 24 S  corporations  and  partnerships  with  large  volumes                                                                                               non-resident partners included in the composite return                                                                                            24 
 25 of  shareholders  and  partners  may  file  a  schedule                                                                                                filing.                                                                                                                                           25 
 26 condensing the information from A-1 schedules in lieu of                                                                                                                                                                                                                                                 26 
 27 filing individual A-1 schedules.                                                                                                                       Composite returns  are  due on  the  15th  day  of  the                                                                                           27 
 28                                                                                                                                                        fourth month  following  the  close  of  the  taxable  year  of                                                                                   28 
 29 Qualifying non-resident individual partners may elect to                                                                                               the shareholders  or  partners  included in  the  composite                                                                                       29 
 30 file the Delaware Form 200-C.  If one or more individuals                                                                                              return.  Federal Extensions  of  Time  to  File  will  be                                                                                         30 
 31 choose  not  to  file  the  Delaware  Form  200-C,  those                                                                                              accepted as a valid extension to file the Delaware Form                                                                                           31 
    individuals must file a Delaware Non-Resident Personal 
                                                                                                                                                           200-C.  Partnerships  can  file  the  Delaware  Extension 
 32 Income Tax Return, Form 200-02. Individuals who are                                                                                                                                                                                                                                                      32 
                                                                                                                                                           Form 1027. 
 33 included in the composite filing must not file an individual                                                                                                                                                                                                                                             33 
 34 non-resident income tax return                                                  reporting  the same                                                                                                                                                                                                      34 
 35 income. Grantor Trusts may also be included in the                                                                                                     The Delaware Division of Revenue requires a Schedule                                                                                              35 
 36 composite return.                                                                                                                                      K-1  for  all  non-resident  corporate shareholders  and                                                                                          36 
 37                                                                                                                                                        non-resident individual partners filing the DelawareForm                                                                                          37 
 38 The  following  limitations  and  conditions  shall  apply  to                                                                                         200-C.                                                                                                                                            38 
 39 those individuals included in the composite return:                                                                                                                                                                                                                                                      39 
 40                                                                                                                                                        The  composite  return  must  be signed  by  a  partner or                                                                                        40 
 41 · No tax credits other than non-refundable credits from                                                                                                corporate  officer  authorized  to  sign  the  partnership                                                                                        41 
 42 Form 700 will be allowed.                                                                                                                              return or S corporation income tax return.                                                                                                        42 
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 46                                                                                                                                                                                                                                                                                                          46 
 47                                                         FOR DELAWARE INCOME TAX FORMS AND INSTRUCTIONS:                                                                                                                                                                                                  47 
 48                                                                                                                                                                                                                                                                                                          48 
 49                                                                                                                                 VISIT                                                                                                                                                                    49 
 50                                                                                                         WWW.REVENUE.DELAWARE.GOV                                                                                                                                                                         50 
 51                                                                                                                                                                                                                                                                                                          51 
 52                                                                                                                                 OR CONTACT                                                                                                                                                               52 
 53                                                                                                         DELAWARE DIVISION OF REVENUE                                                                                                                                                                     53 
 54                                                                                                         CARVEL STATE OFFICE BUILDING                                                                                                                                                                     54 
 55                                                                                             9TH AND FRENCH STREETS, FIRST FLOOR                                                                                                                                                                          55 
 56                                                                                                         WILMINGTON, DE  19801                                                                                                                                                                            56 
 57                                                                                                                                 (302) 577-8994                                                                                                                                                           57 
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 62                                                                                                                                                                                                                                                                                                          62 
 63 (Rev.  021 / 0/1 )6                                                                                                                                                                                                                                                                                      63 
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