Form IT-Addback Fillable Form IT-Addback Related Member Intangible Expenses and Costs and Interest Expenses and Costs (rev. 12/08)
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(Amount eligible for this exception) (Attach a schedule if there are more than four states with respect to questions 4 through 9) (For additional information please see subsection (d) of Code 48 7 28 3 and paragraph (5) of 560 7 3 05 Enter amount here and on the applicable line of the tax return 560 7 3 05(5) 9 Total amount eligible for this exception Add lines 8a through 8d above Add Line 9 of Section C Line 7 of Section D and Line 7 of Section E Addback additional schedules cannot be greater than the amount on Line 1 of Section B Amount of the related member costs paid by the taxpayer and reported by the related member as income subject Amount of the related member costs paid to such related member 7 Amount of the related member costs taxpayer paid directly or indirectly 3 Apportionment ratio (to six decimals) in each respective state applicable to the amount in line 6 If the Attach a separate schedule for each related member Attach a separate schedule for each related member calculations corresponding boxes below costs required to be added back pursuant to Code 48 7 28 3 and Regulation Country of domicile of the related member 3 Department of Revenue elimination Enter the total amount here and on the applicable line of the tax return in the Enter type of tax paid in each state by the related member examples Exception for Expenses Paid Accrued or Incurred to a Related Member Domiciled in a Foreign Exception for Expenses Paid Accrued or Incurred to a Related Member Who Paid Accrued or Exception for Income Allocated or Apportioned to and Taxed by Georgia or Another State Federal Identification Number of such unrelated party 4 Federal Identification Number of the related member 2 Federal Identification Number of the related member 2 Federal Identification Number Taxable Year (Beginning & End) further Georgia subtractions from income section The sum total of all exceptions guidance in the Georgia additions to federal taxable income section Include the amounts from the same lines of any separate schedules attached income prior Incurred Expenses to a Person Who is Not a Related Member (For additional information please see Interest Expenses and Costs IT Addback (12/08) member Please see subparagraph (6)(b)5 of Regulation 560 7 3 05 for the specific information that member Please see subparagraph (7)(b)2 of Regulation 560 7 3 05 for the specific information that Multiply the amounts in line 6 by the factors in the corresponding boxes of line 7 and enter the result in the Name of each state to whom net income tax was paid by the related member on a tax base which included Name of the related member 1 Name of the related member 1 Name of the unrelated party to whom the costs were paid 3 Nation (For additional information please see subsection (e) of Code 48 7 28 3 and paragraph (6) Note: Regulation 560 7 3 05(2) requires that the taxpayer add back related member costs to of Regulation 560 7 3 05) Page 1 of 4 Page 2 of 4 Page 3 of 4 Page 4 of 4 Please Portion of the related member costs paid by such related member to the 7 Provide a brief description of the arm s length status of the transactions between the taxpayer and the Provide a description of the business purpose of the transactions between the related member and the Provide a description of the business purpose of the transactions between the taxpayer and the related Provide a description of the comprehensive income tax treaty: Regulation Regulation 560 7 3 05) related member cost reported to a respective state was allocated in full to that state enter 1 for that state Related Member Intangible Expenses and Costs and Related member intangible expenses and costs and interest expenses and 1 related member Please see subparagraph (5)(d)5 of Regulation 560 7 3 05 for specific information reported on the tax return pursuant to Form IT Addback including any should be included: STATE OF GEORGIA subsection (f) of Code 48 7 28 3 and paragraph (7) of Regulation 560 7 3 05) Taxpayer Information Taxpayer Name Taxpayer Address that should be included: that should be included: the related member costs Do not include jurisdictions in which the related member costs are subject to to allocation and/or apportionment in each respective state to claiming any exception to the addback to such related member Total Amount Eligible for Exception: unrelated party (Amount eligible for this exception) unrelated party Please see subparagraph (7)(b)2 of Regulation 560 7 3 05 for the specific information