Form R-6701 (CIT-624) Corporation Income Tax Request for Tentative Refund

First preceding tax year ended Second preceding tax year ended ( ) ( ) (Signature of officer) Title Date Signature of preparer Date 1 Net operating loss incurred for tax year ended 2 Federal tax refund or credit applicable to the loss (Attach copy of Federal Form 1139 or explanation ) 3 Net operating loss available for carryback (Subtract Line 2 from Line 1 ) 4 Amount of loss utilized in Schedule B (Line 3 below) 5 Net operating loss available for carryforward (Subtract Line 4 from Line 3 ) 1 Net taxable income previously reported 10 Tentative refund (Subtract Line 9 from Line 8 ) 2 Net operating loss previously applied 3 Current loss carryback (Schedule A Line 4) 4 Net taxable income (Subtract Lines 2 and 3 from Line 1 ) 5 Income tax liability (Based on Line 4) 6 New job credits (Limited to 50%) 7 Other Credits 8 Net tax due (Subtract Lines 6 and 7 from Line 5 ) 9 Net tax previously paid A separate refund check will be issued for each period The tax periods are subject to an examination and any tentative refund amounts determined not to be an overpayment may be recovered within two years from December 31 of the year in which the tentative refund was paid The recovered overpayment of refund shall bear interest at the rate provided for in R S 47:1601 computed from the date the tentative refund was issued until payment is received by the department CIT 624 State of Louisiana R 6701 (3/01) Department of Revenue General Instructions In some cases a federal tax deduction adjustment in the prior period may be necessary even though there is no loss carryback for federal purposes Federal taxes paid on income that is not being taxed by Louisiana due to the carryback of the loss cannot be deducted This amount of adjustment to the preceding periods federal tax deductions may be reflected on Schedule A Line 2 Please attach your computation P O Box 201 Baton Rouge LA 70821 0201 R 6701 (3/01) R 6701 (Form CIT 624) Request for Tentative Refund of Corporation Income Tax may only be used to request a refund resulting from the carryback of a net operating loss S chedule B: Computation of tentative refund amount Schedule A is used to compute the amount of loss available for carryback and the balance of the loss that remains to be carried forward Louisiana Revised Statute 47:287 86 G provides that a net operating loss deduction may be carried back to each of the three taxable years preceding the taxable year in which the loss was incurred The loss must be reduced by the amount of federal income tax refund or credit due to the carryback of a loss for federal income tax purposes to the extent that the Federal income tax was deducted from Louisiana net income in a prior year A schedule showing the calculation of the federal tax refund applicable to the loss carryback and a copy of federal Form 1139 Corporation Application for Tentative Refund must be included with your request for tentative refund If no federal tax refund is applicable to the loss carryback a statement of explanation must be included with the refund request Schedule A: Schedule A: Computation of loss amount available for carryback an d carryforward Schedule B is used to compute the tentative refund amount requested from the appropriate preceding tax year The current loss carryback (Line 3) should correspond to the total loss to be utilized as computed in Schedule A Line 4 Any new jobs credits that were claimed on previous returns but due to the election to carry back a net operating loss to that preceding tax period are no longer being utilized may be carried forward and claimed against the tax liability for another period on the schedule Any refund resulting from the carryforward of the new jobs credit should be included in the tentative refund amount Schedule B: Signature and Verification Telephone number Telephone number of preparer Third preceding tax year ended This request is made pursuant to Revised Statute 47:287 86 G allowing the Secretary the discretion to pay certain refunds on a tentative basis subject to later verification and recovery of any amount found not to be a valid overpayment under the law I declare that I have examined this request and to the best of my knowledge and belief it is true correct and complete Declaration of preparer (other than taxpayer) is based on all information of which he has any knowledge