(3 22%)
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(See pg 8 of instr )
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1 Total for Column 5 1
2 Total for Column 6 2
2013 Form 60 page 5
3 Total for Column 7 Enter this amount on Form 60 page 1 line 2 3
4 Total for Column 8 Enter this amount on Form 60 page 1 line 3 4
Address
Address
Address
Address
All corporations must Complete Columns 1 through 5 for EVERY shareholder
All Shareholders
ALL shareholders
attach additional pages
Column 1
Column 2
Column 3 Column 4
Column 5 Column 6 Column 7 Column 8
Complete this column for
complete this schedule Complete Column 6 if shareholder is a nonresident individual or tax exempt organization
composite income tax
copy)
distributive share of
Enter name of corporation FEIN
Exempt Organizations
Federal distributive
Form PWA
If applicable complete Column 7 or Column 8 for a nonresident individual shareholder only
income (loss)
income tax
Individuals and Tax
Name and address of shareholder If additional lines are needed
Nonresident
Nonresident Individual Shareholders Only
North Dakota
North Dakota
North Dakota Office of State Tax Commissioner
Number/FEIN
Ownership
Schedule KS Shareholder information
share of income (loss)
Shareholder
Social Security
State Zip Code
State Zip Code
State Zip Code
State Zip Code
Type of entity
withheld (3 22%)
www nd gov/tax
