Form F-1120 Florida Corporate Income/Franchise Tax Return for 2012 Tax Year R.01/13

(a) (b) (a) (b) (c) (d) (e) (a) Amount of overpayment from last year elected for credit (a) Enter s 78 IRC income $ (a) Enter s 951 IRC subpart F income $ (attach schedule) (b) less direct and indirect expenses $ Total (b) Payments made on estimated tax declaration (Florida Form F 1120ES) 2b $ (b) plus s 862 IRC dividends $ (c) less direct and indirect expenses $ Total (c) Total of Lines 2(a) and 2(b) 2c $ (Enter here and on Page 1 Line 8 or Schedule VI Line 8 for AMT) (Enter here and on Schedule II Line 7) (extension of time) if applicable (Numerator) (Denominator) (Numerator) (Denominator) Rounded to Six Decimal If any factor in Column (b) is zero Rounded to Six Decimal (see instructions for Schedule VI) * Taxpayers subject to federal alternative minimum tax must compute Florida alternative 1 Federal taxable income (see instructions) 1 Insurance companies (attach copy of Schedule T Annual Report) 1 Inventories of raw material work in process finished goods 1 Sales (gross receipts) 10 Florida net income (Line 7 plus Line 8 minus Line 9) 11 Tax due: 5 5% of Line 10 or amount from Schedule VI whichever is greater 16 Payment credits: Estimated tax payments 16a $ 2 Buildings and other depreciable assets 2 Sales delivered or shipped to Florida purchasers 2 State income taxes deducted in computing federal taxable income 2 Transportation services 3 Additions to federal taxable income (from Schedule I) 3 Land owned 3 Other gross receipts (rents royalties interest etc when applicable) 4 Other tangible and intangible (financial org only) assets (attach schedule) 4 Total of Lines 1 2 and 3 4 TOTAL SALES (Enter on Schedule III A Line 3 Columns [a] and [b]) 5 Subtractions from federal taxable income (from Schedule II) 5 Total (Lines 1 through 4) 5050 W Tennessee St 6 Adjusted federal income (Line 4 minus Line 5) 6 Average value of property 7 Florida portion of adjusted federal income (see instructions) 7 Rented property (8 times net annual rent) 8 Nonbusiness income allocated to Florida (from Schedule R) 8 Total (Lines 6 and 7) Enter on Line 1 Schedule III A Columns (a) and (b) 9 Florida exemption a Add Line 5 Columns (a) and (b) and divide by 2 (for within Florida) 6a a Beginning of year b End of year c Beginning of year d End of year a Enter Lines 6 a plus 7 a and also enter on Schedule III A Line 1 a Rented property in Florida 7a a) Contact person telephone number: ( ) a) List years examined: Attach a copy of your federal return Attach a copy of your Florida Form F 7004 Attach pages 1 5 of federal return b Add Line 5 Columns (c) and (d) and divide by 2 (for total everywhere) 6b b Enter Lines 6 b plus 7 b and also enter on Schedule III A Line 1 b Rented property Everywhere 7b below to determine the amended amounts to be entered on the declaration (Florida Form F 1120ES) c) Interest: F 2220 d) Other Line 14 Total 14 City: State: ZIP: Column (a) Column (a) for total average property in Florida 8a Column (b) Column (b) Column (b) for total average property Everywhere 8b Contact person for questions: Contact person for questions: Contact person for questions: due here and on payment coupon If the amount is negative (overpayment) enter on Line 18 and/or Line 19 17 Enter total credits on Page 1 Line 12 FEIN from federal consolidated return: Florida Department of Revenue Florida Form F 1120N) 2 $ Florida Income/Franchise Grand total Total of Lines 1 and 2 3 here and on payment coupon 18 III A For use by taxpayers doing business outside Florida except those providing insurance or transportation services III B For use in computing average value of property (use original cost) III C Sales Factor TOTAL WITHIN FLORIDA TOTAL EVERYWHERE III D Special Apportionment Fractions (see instructions) (a) WITHIN FLORIDA (b) TOTAL EVERYWHERE (c) FLORIDA Fraction ([a] 4 [b]) Income/Franchise Tax Income/Franchise Tax Last day of 9th month Enter 0 25 of Line 4 5c Last day of fiscal year Enter 0 25 of Line 4 5d Less: Credits against the tax $ 4 $ Make your check payable to the Florida Department of Revenue minimum tax at 3 3% and enter the greater of these two computations Name of corporation: NOTE: If your estimated tax should change during the year you may use the amended computation payment amounts: Last day of 6th month Enter 0 25 of Line 4 5b Payment due dates and Last day of 4th month Enter 0 25 of Line 4 5a Phone number: ( ) Phone number: ( ) Places see note on Page 9 of the instructions Places Sign your check and return Tallahassee FL 32399 0100 Telephone number: ( ) Tentative tax payment 16b $ 16 The address below is not correct The business location changes The corporation name changes The payment for June 2013 is due on or before June 28 2013 to estimated tax and applied to date 2a $ Total allocated elsewhere 2 Total allocated to Florida 1 Type Amount Type State/country allocated to Amount US Dollars Cents WITHIN FLORIDA TOTAL EVERYWHERE WITHIN FLORIDA TOTAL EVERYWHERE Col (a) 4 Col (b) Weight Weighted Factors Write your FEIN on your check (example) (example) (example) (example) (example) (Mark X in (See reverse side) (See reverse side) (See reverse side) 0 1 2 3 4 5 6 7 8 9 0123456789 0123456789 0123456789 0123456789 0123456789 0123456789 1 Amended estimated tax 1 $ 1 Amount of this installment 1 Amount of this installment 1 Apportionable adjusted federal income from Page 1 Line 6 (or Line 6 Schedule VI for AMT in Col [b]) 1 Federal alternative minimum taxable income after exemption (attach federal Form 4626) 1 Florida health maintenance organization credit (attach assessment notice) 1 Florida income expected in taxable year 1 $ 1 Gross foreign source income less attributable expenses 1 Interest excluded from federal taxable income (see instructions) 1 Property (Schedule III B below) X 25% or 1 Tentative amount of Florida tax for the taxable year 1 Who must make estimated tax payments Every domestic or foreign corporation or other entity subject to taxation under the provisions of Chapter 220 Florida Statutes must declare estimated tax for the taxable year if the amount of income tax liability for the year will be more than $2 500 1 Who must make estimated tax payments Every domestic or foreign corporation or other entity subject to taxation under the provisions of Chapter 220 Florida Statutes must declare estimated tax for the taxable year if the amount of income tax liability for the year will be more than $2 500 10 Florida alternative minimum tax (AMT) credit 10 Florida net income (Line 7 plus Line 8 minus Line 9) 10 Rural and/or urban high crime area job tax credits 10 s 168(k) IRC special bonus depreciation (see instructions) 11 Contaminated site rehabilitation tax credit (attach tax credit certificate) 11 Florida alternative minimum tax due (3 3% of Line 10) See instructions for Page 1 Line 11 11 Other subtractions (attach statement) 11 State housing tax credit 12 Child care tax credits (attach certification letter) 12 Credit for contributions to nonprofit scholarship funding organizations 12 Credits against the tax (from Schedule V) 12 Total Lines 1 through 11 in Columns (a) and (b) Enter totals for each column on Line 12 Column (a) total is also entered on Page 1 Line 5 (of Florida Form F 1120) Column (b) total is also entered on Schedule VI Line 5 13 Renewable energy tax credits 13 State housing tax credit (attach certification letter) 13 Total corporate income/franchise tax due (Line 11 minus Line 12) 14 a) Penalty: F 2220 b) Other 14 Credit for contributions to nonprofit scholarship funding organizations (attach certificate) 14 s 179 IRC expense above $128 000 15 Florida renewable energy technologies investment tax credit 15 s 168(k) IRC special bonus depreciation 15 Total of Lines 13 and 14 15 16 Florida renewable energy production tax credit 16 New markets tax credit 17 Entertainment industry tax credit 17 New markets tax credit 17 Total amount due: Subtract Line 16 from Line 15 If positive enter amount 18 Credit: Enter amount of overpayment credited to next year s estimated tax 18 Entertainment industry tax credit 18 Research and Development tax credit 19 Energy Economic Zone tax credit 19 Jobs for the unemployed tax credit 19 Refund: Enter amount of overpayment to be refunded here and on payment coupon 19 2 Amount of overpayment from last year for credit to estimated tax and applied to this installment 2 Amount of overpayment from last year for credit to estimated tax and applied to this installment 2 Capital investment tax credit (attach certification letter) 2 Due Date The payment for June 2013 is due on or before June 28 2013 Generally estimated tax must be paid on or before the last day of the 4th 6th and 9th month of the taxable year and the last day of the taxable year; 25 percent of the estimated tax must be paid with each installment 2 Due Date The payment for June 2013 is due on or before June 28 2013 Generally estimated tax must be paid on or before the last day of the 4th 6th and 9th month of the taxable year and the last day of the taxable year; 25 percent of the estimated tax must be paid with each installment 2 Florida apportionment fraction (Schedule III A Line 4 or Schedule III D Column [c]) 2 Florida exemption $50 000 (Members of a controlled group see instructions on Page 14 of 2 Gross subpart F income less attributable expenses 2 Less: 2 LESS: Estimated tax payments for the taxable year 2 Payroll X 25% or 2 State income taxes deducted in computing federal taxable income (attach schedule) 2 Undistributed net long term capital gains (see instructions) 20 Other additions (attach statement) 20 Research and Development tax credit 21 Energy Economic Zone tax credit 21 Total Lines 1 through 20 in Columns (a) and (b) Enter totals for each column on Line 21 Column (a) total is also entered on Page 1 Line 3 (of Florida Form F 1120) Column (b) total is also entered on Schedule VI Line 3 22 Other credits (attach schedule) 23 Total credits against the tax (sum of Lines 1 through 22 not to exceed the amount on Page 1 Line 11) 3 Additions to federal taxable income (from Schedule I Column [b]) 3 Amended Declaration To prepare an amended declaration write Amended on Florida Form F 1120ES and complete Lines 1 through 3 of the correct installment You may file an amendment during any interval between installment dates prescribed for the taxable year You must timely pay any increase in the estimated tax 3 Amended Declaration To prepare an amended declaration write Amended on Florida Form F 1120ES and complete Lines 1 through 3 of the correct installment You may file an amendment during any interval between installment dates prescribed for the taxable year You must timely pay any increase in the estimated tax 3 Amount of this payment (Line 1 minus Line 2) 3 Amount of this payment (Line 1 minus Line 2) 3 Balance due You must pay 100% of the tax tentatively determined due with this extension request 3 Enterprise zone jobs credit (from Florida Form F 1156Z attached) 3 Estimated Florida net income (Line 1 less Line 2) 3 $ 3 Florida net operating loss carryover deduction (see instructions) 3 Net operating loss deduction (attach schedule) 3 Sales (Schedule III C below) X 50% or 3 Tentative apportioned adjusted federal income (multiply Line 1 by Line 2) 3 Unpaid balance (Line 1 less Line 2(c)) 3 $ 4 Amount to be paid (Line 3 divided by number of remaining installments) 4 $ 4 Apportionment fraction (Sum of Lines 1 2 and 3 Column [e]) Enter here and on Schedule IV Line 2 4 Community contribution tax credit (attach certification letter) 4 Florida net capital loss carryover deduction (see instructions) 4 Interest and Penalties If you fail to comply with the law about filing a declaration or paying estimated tax you will be assessed interest and penalties 4 Interest and Penalties If you fail to comply with the law about filing a declaration or paying estimated tax you will be assessed interest and penalties 4 Net capital loss carryover (attach schedule) 4 Net operating loss carryover apportioned to Florida (attach schedule; see instructions) 4 Total Estimated Florida tax (5 5% of Line 3)* $ 4 Total of Lines 1 through 3 5 Computation of installments: 5 Enterprise zone property tax credit (from Florida Form F 1158Z attached) 5 Excess charitable contribution carryover (attach schedule) 5 Florida excess charitable contribution carryover (see instructions) 5 Net capital loss carryover apportioned to Florida (attach schedule; see instructions) 5 Subtractions from federal taxable income (from Schedule II Column [b]) 5050 W Tennessee Street 6 Adjusted federal alternative minimum taxable income (Line 4 minus Line 5) 6 Employee benefit plan contribution carryover (attach schedule) 6 Excess charitable contribution carryover apportioned to Florida (attach schedule; see instructions) 6 Florida employee benefit plan contribution carryover (see instructions) 6 Rural job tax credit (attach certification letter) 7 Employee benefit plan contribution carryover apportioned to Florida (attach schedule; see instructions) 7 Enterprise zone jobs credit (Florida Form F 1156Z) 7 Florida portion of adjusted federal income (see instructions) 7 Nonbusiness income (from Schedule R Line 3) 7 Urban high crime area job tax credit (attach certification letter) 8 Ad valorem taxes allowable as enterprise zone property tax credit (Florida Form F 1158Z) 8 Eligible net income of an international banking facility (see instructions) 8 Emergency excise tax (EET) credit (see instructions and attach schedule) 8 Nonbusiness income allocated to Florida (see instructions) 8 Total carryovers apportioned to Florida (add Lines 4 through 7) 9 Adjusted federal income apportioned to Florida (Line 3 less Line 8; see instructions) 9 Florida exemption 9 Guaranty association assessment(s) credit 9 Hazardous waste facility tax credit 9 s 179 IRC expense (see instructions) 9100 0 20129999 0002005030 3 3999999999 0000 2 9100 0 20129999 0002005037 6 3999999999 0000 2 9100 0 20129999 0002005999 5 3999999999 0000 2 9100 0 20139999 0002005033 7 3999999999 0000 2 9100 0 20139999 0002005033 7 3999999999 0000 2 A If applicable state the reason you need the extension: A State of incorporation: Address Address Address Address Address Adjusted All Taxpayers Must Answer Questions A Through M Below See Instructions AMT Income An extension for Florida tax purposes may be granted even though no federal extension was granted See Rule 12C 1 0222 F A C for information on the requirements that must be met for your request for an extension of time to be valid and address Are you a corporation/partnership required to file sales and use tax returns? B Florida Secretary of State document number: B Type of federal return filed: Business Business location Business telephone ( ) County C Florida consolidated return? YES NO CHANGE Change of Address or Business Name Check here Check here Check here Check here Check here if any changes have been made to name or address Check here if you transmitted funds electronically Check here if you transmitted funds electronically Check here if you transmitted funds electronically check if self employed City State ZIP City/St/ZIP City/St/ZIP City/St/ZIP City/State/ZIP City: County: State: ZIP: Closing or Sale of Business or Change of Legal Entity Column (a) Complete this form sign it and mail it to the Department if: Computation of Florida Net Income Tax Corporation D Initial return Final return (final federal return filed) Declaration/Installment of Florida Estimated Income/Franchise Declaration/Installment of Florida Estimated Income/Franchise DOR use E Taxpayer election section (s ) 220 03(5) Florida Statutes (F S ) General Rule Election A Election B Effective 01/13 Effective 01/13 Effective 01/13 ENDING Enter FEIN if not pre addressed Enter name and address if not pre addressed: Estimated tax payment Estimated tax payment Estimated Tax Payment Estimated Tax Payment Estimated Tax Worksheet Extension of Time Request F 1120 F 1120 F 1120 F 1120 F 1120 F 1120ES F 1120ES F 1120ES F 1120ES F 1120ES F 1120ES F 1120ES F 7004 F 7004 F Principal Business Activity Code (as pertains to Florida) Federal Employer Identification Number (FEIN) Federal Income FEIN of entity FILING STATUS Firm s name (or yours if self employed) Florida Administrative Code Florida Administrative Code Florida Administrative Code Florida Corporate Income/Franchise Tax Return Florida Department of Revenue Florida Department of Revenue Corporate Income Tax Florida Department of Revenue Corporate Income Tax Florida Department of Revenue Corporate Income Tax Florida Tentative Income / Franchise Tax For calendar year 2012 or tax year beginning 2012 ending For page 1 For Schedule VI AMT For Taxable Years Beginning On or After January 1 2013 from Line 18 from Line 19 G A Florida extension of time was timely filed? YES NO H 1 Corporation is a member of a controlled group? YES NO If yes attach list H 2 Part of a federal consolidated return? YES NO If yes provide: H 3 The federal common parent has sales property or payroll in Florida? YES NO I Location of corporate books: if negative if negative if negative if negative If typing type through the boxes If typing type through the boxes If typing type through the boxes If you are requesting a refund (Line 19) send your return to: If your return is not signed or improperly signed and verified it will be subject to a penalty The statute of limitations will not start until your return is properly signed and verified Your return must be completed in its entirety In care of Information for Filing Florida Form F 1120ES Information for Filing Florida Form F 1120ES Information for Filing Florida Form F 7004 Installment # Installment # J Taxpayer is a member of a Florida partnership or joint venture? YES NO K Enter date of latest IRS audit: L Contact person concerning this return: Line 1 Nonbusiness income (loss) allocated to Florida Line 2 Nonbusiness income (loss) allocated elsewhere Line 3 Total nonbusiness income Location M Type of federal return filed 1120 1120S or Mail to: Mailing Mailing address Mailing address of new owner: Make check payable to and mail with return to: Make checks payable to and mail to: Florida Department of Revenue 5050 W Tennessee St Tallahassee FL 32399 0135 Make checks payable to and mail to: Florida Department of Revenue 5050 W Tennessee St Tallahassee FL 32399 0135 Make checks payable to and mail to: Florida Department of Revenue 5050 W Tennessee St Tallahassee FL 32399 0135 NAME FEIN TAXABLE YEAR ENDING NAME FEIN TAXABLE YEAR ENDING Name of new owner: Telephone number of new owner: ( ) Note: Taxpayers doing business outside Florida enter zero on Lines 3 through 6 and complete Schedule IV Office use only Office use only one box only) Owner s telephone ( ) County Page 2 Page 3 Page 4 Page 5 Page 6 Partnership Payment Coupon for Florida Corporate Income Tax Return Do not detach coupon Penalties for failure to pay tax If you are required to pay tax with this application failure to pay will void any extension of time and subject the taxpayer to penalties and interest for failure to file a timely return(s) and pay all taxes due There is also a penalty for a late filed return when no tax is due PO Box 6440 Preparer Preparer s Preparer s PTIN preparers R 01/13 R 01/13 R 01/13 R 01/13 R 01/13 R 01/13 R 01/13 R 01/13 R 01/13 Remember: Return and Application for Extension of Time to File Return Return is due 1st day of the 4th month after close of the taxable year Rounded to Six Decimal Places Rule 12C 1 051 Rule 12C 1 051 Rule 12C 1 051 Sales and Use Tax Certificate Number Schedule I Additions and/or Adjustments to Federal Taxable Income Schedule II Subtractions from Federal Taxable Income Schedule III Apportionment of Adjusted Federal Income Schedule IV Computation of Florida Portion of Adjusted Federal Income Schedule R Nonbusiness Income Schedule V Credits Against the Corporate Income/Franchise Tax Schedule VI Computation of Florida Alternative Minimum Tax (AMT) Sign here Sign here: Date: signature Signature A person authorized by the taxpayer must sign Florida Form F 7004 They must be (a) an officer or partner of the taxpayer (b) a person currently enrolled to practice before the Internal Revenue Service (IRS) or (c) an attorney or Certified Public Accountant qualified to practice before the IRS under Public Law 89 332 Signature of officer (must be an original signature) Signature of Officer (Required) Date Signature of officer (Required) Date Telephone number ( ) Tallahassee FL 32314 6440 Tallahassee FL 32399 0135 Tax Due Tax for Taxable Year Beginning on or After January 1 2013 Tax for Taxable Year Beginning on or After January 1 2013 Taxable year end Taxable year end Taxable year end: Tentative tax due The business was closed permanently on / / (The Department will remove your corporate income tax obligation as of this date ) The business was sold on / / The new owner information is: The Florida Form F 7004 must be filed To receive an extension of time to file your Florida return Florida Form F 7004 must be timely filed even if you have already filed a federal extension request A federal extension by itself does not extend the time to file a Florida return The legal entity changed on / / If you change your legal entity and are continuing to do business in Florida and the corporation is registered for Sales and Use Tax you must complete a new Florida Business Tax Application (Form DR 1) formerly called an Application to Collect and/or Report Tax in Florida This return is considered incomplete unless a copy of the federal return is attached Title To ensure proper credit to your account enclose your check with tax return when mailing To file online go to www myflorida com/dor To file online go to www myflorida com/dor To file online go to www myflorida com/dor Total amount due from Line 17 Total credit Total refund Transfer the amount on Line 3 to Estimated tax payment box on front Transfer the amount on Line 3 to Estimated tax payment box on front Transfer the amount on Line 3 to Tentative tax due on reverse side Under penalties of perjury I declare that I have been authorized by the above named taxpayer to make this application and that to the best of my knowledge and belief the statements herein are true and correct: 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 Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge US DOLLARS CENTS US DOLLARS CENTS US DOLLARS CENTS Use black ink Example A Handwritten Example B Typed When to file File this application on or before the original due date of the taxpayer s corporate income tax or partnership return Do not file before the end of the tax year Where to Send Payments and Returns Write your numbers as shown and enter one number per box Write your numbers as shown and enter one number per box Write your numbers as shown and enter one number per box Year end date You must write within the boxes You must write within the boxes You must write within the boxes