Delaware Form 200-C - Delaware Composite Personal Income Tax Return - 2009
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1DELAWARE
TAX YEAR
FORM 200-C
2009
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DELAWARE COMPOSITE
PERSONAL INCOME TAX RETURN
DO NOT WRITE OR STAPLE IN THIS AREA
FISCAL YEAR _______/_______/_______ TO _______/_______/_______
CHECK APPLICABLE BOX:
INITIAL RETURN
FINAL RETURN
AMENDED RETURN
LIST NUMBER OF NON-RESIDENT PARTNERS/SHAREHOLDERS: ___________
NAME OF BUSINESS
ADDRESS
CITY
STATE
ZIP CODE
DELAWARE ADDRESS (IF DIFFERENT)
CITY
STATE
ZIP CODE
DATE AND STATE OF INCORPORATION
EMPLOYER IDENTIFICATION OR SOCIAL SECURITY NUMBER
NATURE OF BUSINESS
00
1. DELAWARE SOURCED INCOME (NON-RESIDENTS ONLY)...............................................................................
1.
00
2. TAX LIABILITY (MULTIPLY LINE 1 BY .0595)........................................................................................................
2.
00
3.
NON REFUNDABLE CREDITS (MUST ATTACH FORM 700)................................................................................
3.
00
BALANCE (SUBTRACT LINE 3 FROM LINE 2. CANNOT BE LESS THAN ZERO)...............................................
4.
4.
00
5. ESTIMATED TAXES PAID (S CORPORATIONS ATTACH COPY OF FORM 1100-S, SCHEDULE A-1).............
5.
00
6. IF LINE 5 IS LESS THAN LINE 4, SUBTRACT LINE 5 FROM LINE 4 AND ENTER HERE...........PAY IN FULL>
6.
00
7. IF LINE 4 IS LESS THAN LINE 5, SUBTRACT LINE 4 FROM LINE 5 AND ENTER HERE..................REFUND>
7.
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. IF PREPARED BY A PERSON OTHER THAN THE TAXPAYER, HIS
DECLARATION IS BASED ON ALL INFORMATION OF WHICH HE HAS ANY KNOWLEDGE.
SIGNATURE OF AUTHORIZED OFFICER
TITLE
DATE
SIGNATURE OF PREPARER
PREPARER'S EMPLOYER ID OR SOCIAL SECURITY NUMBER
DATE
ADDRESS OF PREPARER (STREET, CITY, STATE, ZIP CODE)
PREPARER'S PHONE
MAKE CHECK PAYABLE AND MAIL TO: DELAWARE DIVISION OF REVENUE, P.O. BOX 508, WILMINGTON, DE 19899-0508
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