Form 109 - California Exempt Organization Business Income Tax Return - 2001
ADVERTISEMENT
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5California Exempt Organization
YEAR
FORM
2001
Business Income Tax Return
109
For calendar year 2001 or fiscal year beginning month _______ day _______ year 2001, and ending month _______ day _______ year ______ .
¼
¼
California corporation or organization number
FEIN
C Final return?
Dissolved
Surrendered (Withdrawn)
-
¼
Merged/Reorganized
¼
_________________________
If a box is checked, enter effective date
Corporation/organization name
D Nature of trade or business ________________________________________
E Accounting method used _________________________________________
Address
PMB no.
F Is this organization a non-exempt charitable trust as
described in IRC Section 4947(a)(1)? . . . . . . . . . . . . . . . . . . .
Yes
No
City
State
ZIP Code
G Is this organization claiming any enterprise zone, Los Angeles Revitalization
Zone (LARZ), Local Agency Military Base Recovery Area (LAMBRA),
Targeted Tax Area (TTA), or Manufacturing Enhancement Area (MEA)
A Is this an education IRA within the meaning of R&TC Section 23712? . . . . . . . . . . . . . . .
Yes
No
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tax benefits? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
B Is the organization currently under audit? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
H Unrelated Business Activity (UBA) Code
Organizations Taxable as Corporations
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1 Unrelated business taxable income from Side 2, Part II, line 30 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
Attach
Check
2 Multiply line 1 by the average apportionment percentage ________% from the Schedule R,
or
¼
Apportionment Formula Worksheet, line 6. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Money
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3 Enterprise zone, LAMBRA, LARZ, TTA, or Pierce’s disease losses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
Order
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4 Net operating loss deduction from form FTB 3805Q. See General Information M . . . . . . . . . . . . . . . . . . .
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¼
5 Add line 3 and line 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
¼
6 Net unrelated business taxable income. Subtract line 5 from the lesser of line 1 or line 2 . . . . . . . . . . . .
6
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7 Tax. ________% x line 6. See General Information J . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
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8 Tax credits from Schedule B, line 7, or Schedule P (100). See Schedule B instructions . . . . . . . . . . . . . .
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9 Balance. Subtract line 8 from line 7. If line 8 is greater than line 7, enter -0- . . . . . . . . . . . . . . . . . . . . . .
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Organizations Taxable as Trusts
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10 Unrelated business taxable income from Side 2, Part II, line 30 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
Tax
¼
Compu-
11 Enterprise zone, LAMBRA, LARZ, TTA, or Pierce’s disease losses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
tation
¼
12 Net operating loss deduction from form FTB 3805V. See General Information M . . . . . . . . . . . . . . . . . . . .
12
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13 Add line 11 and line 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
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14 Net unrelated business taxable income. Subtract line 13 from line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
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15 Tax on amount on line 14. See General Information J . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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16 Tax credits from Schedule B, line 7, or Schedule P (541). See Schedule B instructions . . . . . . . . . . . . . . .
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17 Balance. Subtract line 16 from line 15. If line 16 is greater than line 15, enter -0- . . . . . . . . . . . . . . . . . . .
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18 Tax from line 9 or line 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18
Total
Tax
19 Alternative minimum tax. See General Information N . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
19
20 Total tax. Add line 18 and line 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
20
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5
21 Overpayment from a prior year allowed as a credit . . . . . . . . . . . . . .
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1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5
Payments
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5
22 2001 estimated tax payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5
23 Amount paid with automatic extension (FTB 3539) . . . . . . . . . . . . . .
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1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5
24 Total payments and credits. Add line 21 through line 23 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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25 Tax due. Subtract line 24 from line 20. Pay entire amount with return. See instructions . . . . . . . . . . . . . .
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Refund
(Direct
26 Overpayment. Subtract line 20 from line 24. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26
Deposit of
27 Enter amount of line 26 to be applied to 2002 estimate tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
27
Refund) or
Amount
28 Refund. Enter amount of line 26 to be refunded. Subtract line 27 from line 26 . . . . . . . . . . . . . . . . . . . . .
28
Due
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a Fill in the account information to have the refund directly deposited. Routing number . . . . .
28a
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¼
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b Type: Checking
Savings
c Account Number . . . . . . . . . . . . . . . . . . . . . . . . . . .
28c
29 Penalties and interest. See General Information L . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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30
Check if estimate penalty computed using Exception B or C and attach form FTB 5806.
31 Total amount due. Add line 25 and line 29. Pay with return . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Person to contact for additional information:
Telephone (
)
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct,
and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Please
Sign
(
)
Here
Signature of officer
Date
Title
Daytime telephone
Date
Preparer’s SSN/PTIN
Preparer’s
Check if
Paid
signature
self-
FEIN
-
Preparer’s
employed
Firm’s name (or yours, if
Use Only
self-employed) and address
Daytime telephone (
)
10901104
Form 109
2001 Side 1
For Privacy Act Notice, get form FTB 1131.
C1
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