Print Form DO NOT WRITE OR STAPLE IN THIS AREA - REVENUE CODE 0042 1100X AMENDED DELAWARE CORPORATION INCOME TAX RETURN Reset for Fiscal year beginning and ending Name of Corporation EMPLOYER IDENTIFICATION NUMBER Street Address City State Zip Code Did you file a Federal Amended Return: Delaware Address if Different than Above Is this Return being filed due to an IRS audit: City State Zip Code State of Incorporation: Nature of Business: A B C IMPORTANT - ORIGINALLY NET CHANGE CORRECT ALL schedules and lines MUST be completed. REPORTED Increase/Decrease AMOUNT 1. FederalTaxable Income.............................................................................. 2. Subtractions: 1 00 00 00 1 (a)Foreign dividends, interest and royalties................................................ 2a 00 00 00 2a (b)Net interest from U.S. securities (Schedule 1, Column 2)........................ 2b 00 00 00 2b (c)Interest from affiliated companies (Schedule 1, Column 3)..................... 2c 00 00 00 2c (d)Gain from sale of U.S. or Delaware securities ......................................... 2d 00 00 00 2d (e)Wage deduction -Federal Jobs Credit..................................................... 2e 00 00 00 2e (f) Handicapped accessibility deduction (Attach statement) ........................ 2f 00 00 00 2f (g)Net operating loss carry-over................................................................... 2g 00 00 00 2g (h)Other.......................................................................................................... 2h 00 00 00 2h (i) Total [Lines 2(a) through 2(h) ]................................................................. 2i 00 00 00 2i 3. Line 1 minus Line 2 (i)................................................................................... 3 00 00 00 3 4. Additions: (a)All state and political subdivision income tax deducted in computing Line 1 4a 00 00 00 4a (b)Loss from sale of U.S. or Delaware securities ......................................... 4b 00 00 00 4b (c)Interest income from obligations of any state except DE (Sch. 1, Col. 4) 4c 00 00 00 4c (d)Depletion allowance - oil and gas .............................................................. 4d 00 00 00 4d (e)Interest paid affiliated companies ............................................................ 4e 00 00 00 4e (f) Donations included in Line 1for which Delaware income tax credits were granted .......................................................................................... 4f 00 00 00 4f (g)Total [Lines 4(a) through 4 (f)].................................................................. 4g 00 00 00 4g 5. Entire Net Income [Line 3 plus Line 4(g)]..................................................... 5 00 00 00 5 6. Total non-apportionable income (or loss) (Schedule 2, Column 3)................ 6 00 00 00 6 7. Income(orloss)subjecttoapportionment (Line5minusLine6)................. 7 00 00 00 7 8. Apportionment percentage (Schedule 3D,Page 2) ...................................... 8 00 00 00 8 9. Income (or loss) apportioned to Delaware (Line 7multipliedby Line 8)......... 9 00 00 00 9 10. Non-apportionable income (or loss) (Schedule 2, Column 1)....................... 10 00 00 00 10 11. Total (Line 9 plus or minus Line 10) ................................................................ 11 00 00 00 11 12. DelawareTaxable Income (Line 5 or Line 11 whichever is less)................... 12 00 00 00 12 13. Tax @ 8.7%................................................................................................. 13 00 00 00 13 14. Delaware tentative tax paid.................................................................................................................................................. 14 00 14 15. Credit carry-over from prioryears........................................................................................................................................ 15 00 15 16. Other payments (Attach statement)..................................................................................................................................... 16 00 16 17. Approved income tax credits................................................................................................................................................ 17 00 17 18. Previousoverpayments...................................(a) Less: Refund claimed and received................................................... 18a ( 00)18a (b) Less: Tentative tax carry-over previously requested.......................... 18b ( 00)18b 19. Total payments and credits (Less refunds and carry-overs) ................................................................................................ 19 00 19 20. (a) If Line 13 is greater than Line 19 enter BALANCE DUE ................................................................................................ 20a 00 20a (b) Interest at 1% per month................................................................................................................................................ 20b 00 20b (c)TotalTax and Interest Due .............................................................................................................................................. 20c 00 20c 21. If Line 19 is greater than Line 13 enter OVERPAYMENT (a)TotalOVERPAYMENT .................................................... (FOROFFICEUSEONLY ) 21a 00 21a (b) to be ..........................................................REFUNDED (Computed Interest ) 21b 00 21b *DF12213019999* b o t ) c ( C e RE T I D ED TO TENTA V I T E TAX . . .... . . . . . . . . . . . . 21c 00 21c |
SCHEDULE 1 - INTEREST INCOME FORM 1100X PAGE 2 Description Of Column 1 Column 2 Column 3 Column 4 Column 5 Interest Foreign Interest Interest Received Interest Received From Interest Received Other Interest From U.S. Securities Affiliated Companies From State Obligations Income 1 00 00 00 00 00 1 2 00 00 00 00 00 2 3 00 00 00 00 00 3 4 00 00 00 00 00 4 5 00 00 00 00 00 5 6 Totals 00 00 00 00 00 6 SCHEDULE 2 - NON-APPORTIONABLE INCOME ALLOCATED WITHIN AND WITHOUT DELAWARE Description Column 1 Column 2 Column 3 WithinDelaware Without Delaware Total 1 Rentsandroyalties from tangibleproperty 00 00 00 1 2 Royalties from patents and copyrights 00 00 00 2 3 Gains or(losses) fromsale ofrealproperty 00 00 00 3 4 Gains or(losses) fromsale ofdepreciable tangible property 00 00 00 4 5 Interest income from Schedule 1, Columns 4 and 5, Line 6 00 00 00 5 6 Total 00 00 00 6 7 Less: Applicable expenses (Attach statement) 00 00 00 7 8 Totalnon-apportionableincome 00 00 00 8 SCHEDULE 3 - APPORTIONMENT PERCENTAGE Schedule 3-A - Gross Real and Tangible Personal Property WithinDelaware Withinand Without Delaware Description Beginningof Year End ofYear Beginningof Year End of Year 1 Real and tangible propertyowned 00 00 00 00 1 2 Real and tangibleproperty rented (Eight times annual rental paid) 00 00 00 00 2 3 Total 00 00 00 00 3 4 Less: Value atoriginal costofrealand tangible property, the 00 00 00 00 4 income from which is separately allocated (See instructions) 5 Total 00 00 00 00 5 6 Average value (Seeinstructions) 00 00 6 Schedule 3-B- Wages, Salaries,and Other Compensation Paid or Accrued to Employees Description WithinDelaware Within and Without Delaware 1 Wages, salaries,and other compensation of allemployees 00 00 1 2 Less: Wages, salaries, and other compensation of general executive officers 00 00 2 3 Total 00 00 3 Schedule 3-C - Gross Receipts Subject to Apportionment 1 Grossreceipts fromsales of tangiblepersonalproperty 00 00 1 2 Gross income from other sources (Attach statement) 00 00 2 3 Total 00 00 3 Schedule 3-D - Determination of Apportionment Percentage 1 Average value ofrealand tangible propertywithinDelaware 00 % 1 = 2 Average value ofrealand tangible propertywithinandwithoutDelaware 00 2 3 Wages, salaries and other compensationpaid to employeeswithinDelaware 00 = % 3 4 Wages, salaries and other compensationpaid to employeeswithinandwithoutDelaware 00 4 5 Gross receipts andgross income fromwithinDelaware 00 = % 5 6 Gross receiptsandgrossincome fromwithinandwithoutDelaware 00 6 7 Total 7 8 Apportionment percentage (Seeinstructions) *DF12213029999* % 8 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, the declaration is based on all information of which the preparer has any knowledge. Date Signature of Officer Title Email Address Date Signature of individual or firm preparing the return Address MAKE CHECK PAYABLE AND MAIL TO: Delaware Division of Revenue, P.O. Box 2044, Wilmington, DE 19899-2044 (Form Revised 01/27/14) |