% % 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 Community Development Assistance Act 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 Royalties 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 2013
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
revenue nebraska gov 800 742 7474 (NE and IA) 402 471 5729
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
