Form PTE-C Fillable Subchapter K Entities/S Corporations Nonresident Composite Payment Return
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

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