Form 1120-SN-Schd K-1N 2012 Shareholder's Share of Income, Deductions, Modifications, and Credits

% % Final Amended 1 Ordinary business income (loss) 1 10 Other income 10 11 Charitable contributions 11 12 Section 179 expense deduction 12 13 Other deductions and losses 13 14 Qualified U S government interest deduction 14 15 State and local government interest and dividend income 15 16 Income (loss) from non Nebraska sources 16 17 CDAA credit 17 18 Form 3800N credit (see instructions) 18 19 Contractor withholding (see instructions) 19 2 Net income (loss) from rental real estate activities 2 20 Nebraska income tax withheld (see instructions) 20 3 Net income (loss) from other rental activities 3 4 Interest income 4 5 Dividend income 5 6 Royalty income 6 7 Net short term capital gain (loss) 7 8 Net long term capital gain (loss) 8 9 Net Section 1231 gain (loss) 9 Beginning 20 and Ending 20 Check One: Other (describe) Resident Individual Nonresident Individual Estate or Trust S Corporation s Nebraska Apportionment Factor Shareholder s Ownership Percentage If applicable check the appropriate box: Taxable Year of Organization 8 687 2012 City State Zip Code City State Zip Code CORPORATION S NAME AND MAILING ADDRESS FORM 1120 SN Legal Name Name Doing Business As (dba) Name Nebraska ID Number Federal ID Number Social Security Number/Federal ID Number Spouse s Social Security Number NEBRASKA SCHEDULE K 1N PART A PART B PART C Schedule K 1N SHAREHOLDER S NAME AND MAILING ADDRESS Shareholder s Share of Credits Shareholder s Share of Income and Deductions Shareholder s Share of Income Deductions Modifications and Credits Shareholder s Share of Modifications Street or Other Mailing Address Street or Other Mailing Address www revenue ne gov 800 742 7474 (NE and IA) 402 471 5729