Amended return
I authorize a representative of the Department of Revenue to discuss my return and attachments with my preparer
Qualified Investment
S corporation
Subchapter K entity
(A) Non Resident Owner s/Shareholder s Name
(B) Social Security
(C) Entity
(Col E + F)
(Col G X 5%)
(D) Owner s/
(E) Owner s/ Shareholder s
(F) Guaranteed
(G) Total Income
(H) Owner s/
*140001PT*
*140002PT*
*140003PT*
*140004PT*
1 Amount of tax due (see instructions)
1 List general partners
12 Totals page 3 [columns (E) through (H)]
13 Add lines 1 through 12 enter here and on Form PTE C page 3 line 13 columns (E) through (H)
13 Summary totals for additional pages [columns (E) through (H)]
14 Totals [columns (E) through (G)] (lines 12 + 13)
14H Add lines 12 and 13 column (H) and enter here and on page 1 line 1
2 Interest Due
2 List other states in which the Partnership/LLC operates if applicable
3 At any time during the tax year did the Partnership/LLC transact business in a foreign country? Yes No
3 Penalty Due
4 At any time during the tax year did the Partnership/LLC invest in another Pass Through entity? Yes No
4 Total tax interest and penalty due
5 Person to contact for information regarding this return:
5a Overpayment from 2013
6 Amount to be remitted or (overpayment) (subtract line 5d from line 4)
7a Overpayment to be credited to 2015 return
Additional page
ADDRESS
Alabama Department of Revenue
AlAbAmA DepArtment of revenue 2014
and Address
annual Form 65 return for the QIP
are true correct and complete Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge
b Estimated and automatic extension tax payments
b Overpayment amount to be refunded
c Composite payment made on behalf of this entity
Check applicable box:
Check if
Check if amended:
CITY STATE ZIP CODE
d Total of all payments/credits (add lines 5a through 5c)
DEPARTMENT USE ONLY
Do not attach the original Qualified Investment Partnership (QIP) Certification to this return! The certification must be filed with the
DO NOT ATTACH TO OR MAIL WITH FORM 65 OR 20S THIS FORM MUST BE MAILED SEPARATELY
E I Number
Email Address
Email:
Entity s FEIN
FEDERAL EMPLOYER IDENTIFICATION NUMBER FEDERAL BUSINESS CODE
Firm s Name (or yours
For the year January 1 December 31 2014 or other tax year beginning 20 ending 20
For the year January 1 December 31 2014 or other tax year beginning 2014 ending
Form PTE C 2014 Page 2
Form PTE C is used to report Alabama taxable income for all or some of the nonresident owners/shareholders from reported Subchapter K entity or S corporation income and to
Here Your Signature Title or Position Daytime Telephone No Date
IF MORE THAN 11 NON RESIDENT OWNERS/SHAREHOLDERS ATTACH ADDITIONAL PAGES AND ENTER SUMMARY TOTALS ON LINE 13 ABOVE Form PTE C Page 3
If paid by check or money order FORM PTE V MUST ACCOMPANY PAYMENT
If paid electronically check here
if self employed)
If yes complete the information below:
Include with payment Form PTE V available at www revenue alabama gov
Individual & Corporate Tax
Mail to: Alabama Department of Revenue PTE C
make payment on behalf of the owners/shareholders in lieu of individual reporting (CAUTION: Do not include losses on this form )
Make remittance payable to: Alabama Department of Revenue
Montgomery AL 36132 7444
NAME OF COUNTRY
NAME OF ENTITY
NAME OF GENERAL PARTNER
Name:
NATURE OF BUSINESS
Nonresident Composite Payment Return
Number/FEIN
OWNERS/ OWNERS/SHAREHOLDERS WITH A DIFFERENT
Ownership
OWNERSHIP
P O Box 327444
Paid by FEIN
Partnership
Payments
PERCENT OF
Percentage of
Please
Portfolio Income
Preparer s
Preparer s
Preparer s PTIN
Printed Name
PTE C
PTE CK1 AlAbAmA DepArtment of revenue 2014
PTE CK1 Entity s FEIN
REPORTED TO COUNTRY
Required Entity Information For Partnerships and LLCs
Reset Form
Reset Schedule
SCHEDULE
self employed
Share of Nonseparately
Share of Tax Due
Shareholder s
Shareholder s
SHAREHOLDERS IN ENTITY: INCLUDED IN COMPOSITE FILING: ADDRESS CHECK HERE
Signature
SSN / FEIN
Stated Income +
Street Address City State and ZIP
TAXABLE INCOME
Telephone Number
Telephone Number: ( )
TOTAL NUMBER OF NUMBER OF NONRESIDENT IF YOU FILED A 2013 RETURN
UNDER PENALTIES OF PERJURY I declare that I have examined this return and accompanying schedules and statements and to the best of my knowledge and belief they
Use Only
Write Form PTE C tax year and FEIN on remittance for verification purposes