Form 60-KS Additional Schedule KS forms - (fill-in pdf)
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

(3 22%) (attach (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (See pg 8 of instr ) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) 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