Form 04-611x - Amended Alaska Corporation Net Income Tax Return
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1
2AMENDED ALASKA CORPORATION NET INCOME TAX RETURN
FORM
DEPARTMENT USE ONLY
04-611X
.
Federal EIN
EIN used on original return, if different
For the tax year ended:
Name
Telephone Number
Mailing Address
Fax Number
City
State
Zip Code
E-Mail Address
Contact Person
Title
Contact Telephone Number
Is the corporation currently under audit
YES
NO
Name used on original return, if different from above
by the Alaska Department of Revenue?
Note: Complete Part III only to carry back net operating losses and net capital losses
PART I.
ALASKA TAX SUMMARY
(a)
(b)
( c )
DEPARTMENT
As originally reported
Net change
Correct
USE ONLY
(Explain in Part II)
or as adjusted
amount
1. Apportionable income ...................................................
2. Alaska apportionment factor .........................................
3. Alaska apportioned income ...........................................
4. Non-business income (loss)... ......................................
5. Alaska Items... . ...............................................................
6. Alaska Income (Total of lines 3, 4, 5).........................
7. Alaska net operating loss deduction ...........................
8. Alaska Taxable Income..................................................
9. Alaska Income Tax.........................................................
10. Other Taxes......................................................................
11. F ederal-based credits......................................................
12. Total T ax (Total of lines 9, 10, 11)..................................
13. Incentive Credits............... .............................................
14. Alaska Education Credit.................................................
15. Net Alaska income tax. (Total of lines 12, 13, 14) ........
16. Net payments. (Total previous payments less total previous refunds, credits, penalties and interest)
17. (a) If tax on line 15, column (c) is larger than net payments on line 16, enter tax due ..........................
(b) Interest on amount on line 14(a) from___/___/___ to ___/___/___
(See instructions for interest rates) ....................................................................................................
(c) Total amount due ................................................................................................................................
18. If prepayments on line 16 are larger than tax on line 15, column (c), enter overpayment ....................
ADDITIONAL REQUIRED INFORMATION. A complete copy of the federal amended return, if filed, must be provided to constitute a complete amended return
.
I declare, under penalties of perjury, that an original return has been filed for this corporation and that I have examined this return, including
accompanying schedules and statements, and to the best of my knowledge and belief this amended return is true, correct, and complete.
If prepared by a person other than the taxpayer, preparer's declaration is based on all information of which preparer has knowledge.
DEPT USE ONLY
C F W D
Officer's
Date
Title
Signature
REFUND
Preparer's
Date
Check if
Preparer's SSN or PTIN
q
Signature
self-employed
APPROVED
Firm's name (or
EIN
yours if self-employed)
DATE
and address
Zip Code
DEPT USE ONLY
Form 04-611X Webform (Rev 01/03)
Validation Number:
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