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Nebraska Return of Partnership Income FORM 1065N
for the calendar year January 1, 2021 through December 31, 2021 or other taxable year
beginning 2021, and ending , 2021
Name Doing Business As (dba) PLEASE DO NOT WRITE IN THIS SPACE
Legal Name
Street or Other Mailing Address
City State Zip Code Business Class. Code (See Instr.) Date Business Began in Nebraska
Please Type or Print
Principal Business Activity in Nebraska Federal ID Number Nebraska ID Number Does the partnership have nonresident individual partners?
YES (Complete Schedule )II NO
Type of Organization
Partnership Limited Liability Company Publicly Traded Partnership Other (describe) _____________________________________
Check if:
(1) Initial Return (3) Address Change (5) Amended Return (7) Form 3800N, 775N, 312N, or
1107N Attached
(2) Final Return (Example, dissolved. See instr.) (4) Name Change (6) Form 7004 Attached (8) Distributed Form 3800N Credit
1 Ordinary business income (line 22, Federal Form 1065) .............................................................. 1 00
2 Nebraska adjustments increasing ordinary business income (line 12, Schedule A) ..................... 2 00
3 Nebraska adjustments decreasing ordinary business income (line 23, Schedule A) .................... 3 00
4 Nebraska adjusted income (line 1 plus line 2 minus line 3) .......................................................... 4 00
5 Income reported to Nebraska (enter line 4 above or line 3, Schedule I, if applicable) .................. 5 00
If line 5 shows a loss, skip lines 6 and 7 and go to line 8.
6 Income reported to Nebraska subject to withholding (enter the Column (F), Schedule IItotal).... 6 00
7 Nebraska income tax withheld for nonresident individual partners (enter the Column (G),
Schedule II total) ........................................................................................................................... 7 00
8 Form 3800N credit and recapture (see instructions) ..................................................................... 8 00
9 Tax deposited with Form 7004N and 2021 estimated income tax payments ................................ 9 00
10 Nebraska Property Tax Incentive Act Credit Computation (attach Form PTC) ............................. 10 00
11 TAX DUE if line 7 plus line 8 minus lines 9 and 10 is greater than zero. Check this box if your
payment is being made electronically. 11 00
12 Overpayment to be REFUNDED if line 7 plus line 8 minus lines 9 and 10 is less than zero 12 00
Under penalties of perjury, I declare that as taxpayer or preparer, I have examined this return, including accompanying schedules and statements,
and to the best of my knowledge and belief, it is correct and complete.
sign
Signature of Partner or Member Date Email Address
here
( )
Title Phone Number
paid
preparer’s Preparer’s Signature Date Preparer’s PTIN
use only ( )
Print Firm’s Name (or yours if self-employed), Address and Zip Code EIN Daytime Phone
Paper filers must attach a copy of the federal return and supporting schedules to this return.
All filers are encouraged to e-file their return including schedules K-1N.
Mail this return and payment to: Nebraska Department of Revenue, PO Box 94818, Lincoln, NE 68509-4818.
revenue.nebraska.gov, 800-742-7474 (NE and IA), 402-471-5729
8-284-2021
