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Form Bus 417 - Business Tax Return - Industrial Loan And Thrift Companies - Tennessee Department Of Revenue

TENNESSEE DEPARTMENT OF REVENUE

INTERNET (01-15)

RV-R0012601

BUSINESS TAX RETURN - INDUSTRIAL LOAN AND THRIFT COMPANIES

Filing Period

Account No.

FEIN/SSN/TIN

BUS

417

Due Date

Location Address

Make your check payable to Tennessee

Department of Revenue and mail to:

Tennessee Department of Revenue

Classification

Andrew Jackson State Office Building

500 Deaderick Street

Nashville, Tennessee 37242

Returns may also be filed online at

https://apps.tn.gov/biztax/.

_________________________________________________________

Name:

Should you need assistance, please contact the

Taxpayer Services Division by calling our state-

wide numbers: 1-800-342-1003 or (615) 253-

_________________________________________________________

Address:

0600.

(Address to which returns should be mailed)

}

If this is an AMENDED RETURN,

________________________________

State:

_____

__________

please check the box at right.

Zip:

City:

}

If this is a return for a CLOSED

business, please check the

box at right.

ROUND TO NEAREST DOLLAR

.00

(1)

Total gross income of the business............................................................................................. ........

.00

Enter deductions from Schedule A, Line 18.....................................................................................

(2)

.00

(3)

Taxable income of the business (Subtract Line 2 from Line 1)...........................................................

.00

Total business tax (Multiply Line 3 by .003. Enter result not to exceed $1,500. Minimum tax is $450.)......................

(4)

.00

Enter credit memo balance...................................................................................................... ............................

(5)

% . 00

Penalty (See instructions)..................................................................................................... ......................................

(6)

.00

Interest (

% per annum on taxes unpaid by the due date; see instructions)................................................

........

(7)

Total amount due (Add Lines 4, 6, and 7; subtract Line 5)

.00

(8)

(Make checks payable to the Tennessee Department of Revenue).............................................................

I declare this is a true, complete, and accurate return to the best of my

FOR OFFICE USE ONLY