RV-F1406301 (9/21) 

                                TENNESSEE DEPARTMENT OF REVENUE 
                               Franchise and Excise Tax Federal Income Revision 

                 Taxpayer Name                                             FEIN                                                                 Submit form to: 
                                                                                                                                                Tennessee Department of Revenue 
                                                                                                                                                F&E Unit 
                 Account Number                                            Taxable Period Ending                                                P.O. Box 190644 
                                                                                                                                                Nashville, TN  37219-0644 
                                                                                                                                                      Net Change 
 Part 1 - Computation   of Net Earnings Subject to Excise Tax                                                                 As Last Reported  Increase  (Decrease)                  As Amended 
 
 1.  Federal income or loss from Schedule J, Line 1 ............................................                                                                                      
     Additions:                                                                                                                                                                       
 2.  Tennessee excise tax expense (to the extent reported for federal 
     purposes) ........................................................................................................... 
 3.  Contribution carryover from prior period(s) ................................................                                                                                     
 4.  Capital gains offset by capital loss carryover or carryback .......................                                                                                              
 5.  Any depreciation under the provisions of IRC Section 168 not                                                                                                                     
     permitted for excise tax purposes due to Tennessee permanently 
     decoupling from federal bonus depreciation ............................................... 
 6.  Other (specify or attach documentation) ......................................................                                                                                   
 7.  Total additions (add Lines 2 through 6) .........................................................                                                                                
     Deductions:                                                                                                                                                                      
 8.  Dividends received from corporations, at least 80% owned ......................                                                                                                  
 9.  Current year contributions in excess of amount allowed by the                                                                                                                    
     federal government ......................................................................................... 
 10. Portion of current year’s capital loss not included in federal taxable                                                                                                           
     income ................................................................................................................ 
 11. Any income included for federal tax purposes and any depreciation                                                                                                                
     or other expense that could have been deducted for safe harbor 
     lease elections .................................................................................................. 
 12. Any depreciation under the provisions of IRC Section 168 permitted                                                                                                               
     for excise tax purposes due to Tennessee permanently decoupling 
     from federal bonus depreciation .................................................................... 
 13.  Other (specify or attach documentation) ......................................................                                                                                  
 14.  Total deductions (add Lines 8 through 13) ....................................................                                                                                  
     Computation of Taxable Income:                                                                                                                                                   
 15. Total business income (loss) (add Lines 1 and 7, subtract Line 14;                                                                                                               
     if loss, complete Part 2) ................................................................................... 
 16. Apportionment ratio (Schedule N, O, P, R, S, or SE, if applicable,                                                                                                               
     or 100%) .............................................................................................................            %                                        %             % 
 17. Apportionment business income (loss) (multiply Line 15 by Line 16) .......                                                                                                       
 18. Non-business earnings directly allocated to Tennessee (from                                                                                                                      
     Schedule M, Line 9) .......................................................................................... 
 19.  Loss carryover from prior years ....................................................................                                                                            
 20. Income subject to excise tax (add Lines 17 and 18, subtract Line 19) ......                                                                                                      
 21. Excise tax due (multiply Line 20 by 6%, or 6.5% for returns ending on or                                                                                                         
     after July 15, 2002) ............................................................................................ 
 22.  Excise tax paid ...................................................................................................                                                             
 23.  Tax credits ..........................................................................................................                                                          
 24.  Additional excise tax due (overpaid) per federal income revisions                                                                                                               
     (subtract Lines 22 and 23 from Line 21) ........................................................ 
                                                      Under  penalties  of  perjury,  I  declare  that  I  have  examined  this  form,  including  all  accompanying
                                                      schedules and statements,  and to the best of my knowledge and belief, it is true, correct, and complete. 
  Power  of  Attorney  -  Check  YES  if  this        
  taxpayer's  signature  certifies  that  this  tax                                                                                                                      
  preparer  has  the  authority  to  execute  this    Taxpayer's         e                                                             Date                              Title 
  form  on  behalf  of  the  taxpayer  and  is        
  authorized  to  receive  and  inspect
  confidential tax information and to perform         Tax Preparer's Signature                                                        Preparer's PTIN                           Telephone 
  any  and  all  acts  relating  to  respective  tax 
  matters. YES                                        Preparer's Address                                                                                                       State  ZIP Code
                                                      Preparer's Email Address                                                                                                                      

 Taxpayer Name                                                     FEIN                                                                        Account Number 

 Part 2 - Determination of Loss Carryover Available                                                                                            Net Change 
                                                                                                                             As Last Reported  Increase  (Decrease)  As Amended 
 
 1.  Federal income or loss from Part 1, Line 15 ....................................................                                                                
    Additions:                                                                                                                                                       
 2. Dividends and non-business earnings deducted on Schedule J .................... 
 3. Amounts recorded for self-employment tax and qualified pension                                                                                                   
    deductions ............................................................................................................ 
 4. Reduced loss (add Lines 1 through 3; if net amount is positive enter zero)                                                                                       
 5. Excise tax ratio (Schedule N, O, P, R, S or SE, if applicable, or 100%) ...........                                      %                                %      %           
 6. Current year loss carryover available (multiply Line 4 by Line 5) ................