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Bu n i s es s N ema Bu n i s es s N ema DI F /NI E Numb r e E DI F /NI Numb r e
GENERAL TAXGENERALINFORMATIONTAX INFORMATION- MUST BE COMPLETED- MUST BE COMPLETED
Date Business orDateTrustBusinesscreatedor_____Trust/created_____ /__________/ _____ / _____ If you sold yourIfbusinessyou soldoryourreportbusinessyour businessor reportactivityyour businessunder anotheractivity under another
Did you file a returnDid youlastfileyear?a returnYeslast year?No Yes No EIN/FID number,EIN/FIDcompletenumber,the following:complete the following:
Did you have anyDidemployeesyou haveduringany 2 23 ? Yes 21?No Yes NoName of purchaserNameor newof purchaserbusiness:or_____________________________new business: _____________________________
EIN/FID number of purchaser or new business: _____________________EIN/FID number of purchaser or new business: _____________________
On which basisOnarewhichyour recordsbasis are kept?your recordsCashkept? AccrualCash Accrual
Address of purchaser or new business:____________________________Address of purchaser or new business:____________________________
Has your FederalHasTaxyourLiabilityFederalfor anyTaxpriorLiabilityyearforbeenanychangedprior yearinbeenthe changed in the
Are any employeesAreleasedany employeesin the yearleasedcoveredin thebyyearthis return?covered byYesthis return?No Yes No
year covered by this return as a result of an examination by the Internalyear covered by this return as a result of an examination by the Internal
Revenue Service?RevenueYesService?No Yes No If YES, provide theIf YES,name,provideaddress,the name,and FIDaddress,numberandof theFIDleasingnumbercompany:of the leasing company:
If renting, name landlord ______________________________________If renting, name landlord ____________________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
If Business either terminated, was sold, or is not required to fileIf Business either terminated, was sold, or is not required to file
Lakewood tax returns,Lakewoodpleasetaxcompletereturns, pleasethe following:complete the following: WereWere 1099-MISC1099-MISCWereformsor 1099-NEC1099-MISCissued? formsformsYesissued?issued?No Yes No
Date of transaction:Date_____of transaction:/ _____ /__________/ _____ / _____ If YES, attach copiesIf YES,toattachthe endcopiesof thistoreturn.the end of this return.
SCHEDULE WSCHEDULE- RECONCILIATIONW - RECONCILIATIONWITH FEDERALWITHINCOMEFEDERALTAXINCOMERETURNTAXPERRETURNO.R.C. 718RPE O.R.C. 718
Items Not DeductibleItemsNot Deductible Add AddItems Not TaxableItems Not Taxable Deduct Deduct
A. Capital/OrdinaryA. Capital/OrdinaryIRS Section 1231IRSlossesSectiondeducted1231 losses deducted______________ ______________J. Capital/OrdinaryJ. Capital/OrdinaryIRS Section 1231IRSgains,Sectionetc. 1231 gains, etc.
B. 5% of Intangible Income not attributable to sale, exchange,B. 5% of Intangible Income not attributable to sale, exchange, (do not deduct Section 1245 and 1250 gains)(do not deduct Section 1245 and 1250 gains)______________ ______________
or other dispositionor otherof IRSdispositionsection 1221of IRSpropertysection 1221 property______________ ______________. Ke r etnInI ctosme .eKr etnInI ctosme ______________ ______________
. Cb se xaesa To ocnd mi sene.xabCesaT o docn i mne ______________ ______________. L dned isv i D . L dned isv i D ______________ ______________
D. Guaranteed Payments to Partners (not includedD. Guaranteed Payments to Partners (not included M nI . com o r f e p m M eta nI . co e. c te , s tn m o r f p m eta , s tn . c te ______________ ______________
n n i ht i w ) s t i fo r p te n n i ht i w te ) s t i fo r p ______________ ______________N. Other Exempt IncomeN. Other Exempt Income
E. Charitable contributionsE. Charitabledeductedcontributionsabovedeductedcorporate above corporate (attach documentation(attachordocumentationexplanation) or explanation)______________ ______________
limitations limitations including O.R.C. 718.01(A)(1)(g)______________ ______________T. OOTA DED ULCI TT.O TOOSNA DED ULC IOT SN ______________ ______________
F. IRS Section 179F. IRSexpenseSectiondeducted179 expenseabovedeductedcorporate above corporate #3 #3
limitations includinglimitationsO.R.C 718.01(E)(10)including O.R.C 718.01(A)(1)(g)______________ ______________
G. Qualified retirement, health insurance, and life insuranceG. Qualified retirement, health insurance, and life insurance
plans on the behalf of the owners/owner employeesplans on the behalf of the owners/owner employees______________ ______________
H. Other expensesH. Othernot deductibleesexpens not deductible PROOFPROOF
a t tcaod ( chum xae ct trod o cnohu i)trnoao tinenot anaai t(alxpmtene) no i t ana l p ______________ ______________ #123263 #123263
. I TOTA DA L I T I D . I O OT SN TA DA L I T I D O SN ______________ ______________ Black Black
Backer Backer
P. Subtract Line O from Line I and enter net amount on Page 1, Line 2 P. Subtract Line O from Line I and enter net amount on Page 1, Line 2 __________________________________12-26-07 12-26-07
SCHEDULE XSCHEDULE- BUSINESSXALLOCATION- BUSINESS ALLOCATIOFORMULAN FORMULA
a. Located Everywhereateda. Loc Everywhereb. Located in Lakewoodb. Located in Lakewoodc. Percentage (b/a) c. Percentage (b/a)
STEP 1.1.AverageSTEPValue1.1.ofAverageReal &ValueTangibleof RealPersonal& TangiblePropertyersonalP _____________________Property ______________________________________________________________________________ _______________
2.Gross Amount2.RentalsGross AmountPaid MultipliedRentalsbyPaid8 Multiplied_____________________by 8 ______________________________________________________________________________ _______________
3. SubtotalTOT A S TEL 1 3.PSubtotalTOT ALSTE 1 P ____________________________________________________________________________________________ _____%________ _____%
STEP 2. Gross Receipts from Sales Made and /or4. Gross Receipts from Sales Made, Work Per-STEP 2. Gross Receipts from Sales Made and /or4. Gross Receipts from Sales Made, Work Per-
Wformed, kOr oS and/orcr i veWServicesreformed,P ksroromRenderedand/orefrdreScivreOeServicesP sro fmRenderedreed _______________________________________________________________________________ _____________ _____%________ _____%
STEP 5.. 3Wage SS E, seiT5..r3alaPa.ctgPe diae, sS eiWr,alas.ct e P, sdia ____ _____________________ ________________________________________________________________________% _____________%
6..4 P l atcoerTeatn g6.es.4atoTP lcer eatn ges ____ _____________________ ________________________________________________________________________% _____________%
7.. 5A P ega r ecvr7..e 5( cegar ep t nelcaArtn eo t yedb iegauvliaDt netP o( t egaedmegacreprievtcneviyrDep b egafno tmegar ebu tnesfones ruP ebcno regartesnetune )- 4 - deender eiepL t neP , 1 noega, 1 egas ) 4 en i L _____________ %_____________ %
SCHEDULE Z - PARTNER’S DISTRIBUTIVE SHARES OF NET INCOMESCHEDULE Z - PARTNER’S DISTRIBUTIVE SHARES OF NET INCOME
(From Federal(FromSchedulesFederal1065 SchedulesK-1 and10651099) K-1 and 1099)
. 1 N e f o ema ac P h . 1 n t r a N r e o ema f eac P h n t r a r e Re t ned i s R b i r t s i D e S e v i t u ned i st e r ah P f o s r t s i Db i r en t r a v i t uS e e r ah sO fo P r eh t Py aen t r a m r s t ne O r eh t a T Pxya e l bam s t ne A a T m x a T t nuo e l ba x e l ba Am a T t nuo x e l ba
Y/N Y/N Percentage Percentage
Percent PercentAmount Amount
.a .a $% $ $% $ $% $%
.b .b $% $ $% $ $% $%
.c .c $% $ $% $ $% $%
. 2 T TO ALS . 2 T TO ALS 001 % $ 001 % $ $ $ $ $
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