Form 480.30(II) Rev. 03.11
Liquidator:
Serial Number
GOVERNMENT OF PUERTO RICO
20____
20____
DEPARTMENT OF THE TREASURY
Field Audited by:
Income Tax Return for Exempt
Businesses under the Puerto Rico
AMENDED RETURN
Date ______/ ______/ ______
Incentives Programs
Payment Stamp
R
M
N
TAXABLE YEAR BEGINNING ON ________________, _______ AND ENDING ON ________________, ________
Employer's Identification Number
Taxpayer's Name
Department of State Registry No.
Postal Address
Industrial Code
Municipal Code
Merchant's Registration Number
Zip Code
Location of Principal Industry or Business - Number, Street and Country
Telephone Number - Extension
(
)
Date Incorporated
hange of Address
Type of Principal Industry or Business
C
Day_______/ Month_______/ Year _______
Yes
No
Place Incorporated
Receipt No. ___________________________
Contracts with Governmental Entities
eturn
2011 R
Amount: ______________________________
E - mail Address
Yes
No
Spanish
English
a)
00
1.
Tax liability:
Schedule K Incentives, Part I, line 16, Columns A, B and C .........................
(1a)
00
b)
Schedule O Incentives, Part II, line 10 .......................................................
(1b)
c)
00
Schedule V Incentives, Part IV, line 5 ........................................................
(1c)
00
d)
Schedule W Incentives, Part II, line 8 .........................................................
(1d)
e)
00
Schedule X Incentives, Part V, line 11 ........................................................
(1e)
00
f)
Schedule Y Incentives, Part II, line 11 .........................................................
(1f)
g)
00
Schedule Z Incentives, Part II, line 5 ...........................................................
(1g)
(1h)
h)
00
Total (Add lines 1(a) through 1(g)) ...............................................................................................................
(2)
00
Tax on eligible interest (See instructions) ...................................................................................................................................
2.
a)
00
3.
Less:
Tax withheld at source ..............................................................................................
(3a)
b)
Current year estimated tax payments ..........................................................................
00
(3b)
c)
00
Excess from previous years not included on line 3(b) ....................................................
(3c)
d)
00
Tax withheld on partners and stockholders distributable share from special partnerships ...
(3d)
e)
00
Amount paid with automatic extension of time or with original return .................................
(3e)
f)
00
Tax withheld for professional services (Form 480.6B) ....................................................
(3f)
g)
00
Tax withheld at source on eligible interest .....................................................................
(3g)
h)
Total payments (Add lines 3(a) through 3(g)) ..............................................................................................................
00
(3h)
4.
Additional Credit (See instructions) .....................................................................................................................................
00
(4)
5.
Balance of tax due (If the sum of lines 1(h) and 2 is more than the sum of lines 3(h) and 4,
00
enter the difference here, otherwise, on line 8) ....................................
(a)
Tax .................................
(5a)
00
(b)
Interest ............................
(5b)
00
(c)
Surcharges ......................
(5c)
(d)
Total (Add lines 5(a) through 5(c)) ......................................
(5d)
00
6.
Addition to the Tax for Failure to Pay Estimated Tax (Schedule T Incentives, Part II, line 21) ...........................................................
(6)
00
7.
Additional Special Tax (See instructions) ...................................................................................................................................
00
(7)
8.
Excess of tax withheld or paid (See instructions) .......................................................................................................................
(8)
00
9.
Amount paid with this return (Add lines 5(d), 6 and 7 less line 8) .......................................................................................................
00
(9)
10.
Amount overpaid to be credited to estimated tax for 2011 ..............................................................................................................
(10)
00
11.
Contribution to the San Juan Bay Estuary Special Fund ..............................................................................................................
00
(11)
Amount to be refunded ............................................................................................................................................................
12.
(12)
00
13.
Special surtax
(Schedule
N Incentives, Part II, line 6) .............................................................................................................
(13)
00
Less:
a)
Amount paid with automatic extension of time or with original return ................................
14.
(14a)
00
b)
Amount paid in excess from previous year .................................................................
(14b)
00
c)
Credit (Article 1042-7) ...............................................................................................
(14c)
00
d)
Total payments (Add lines 14(a) through 14(c)) ...........................................................................................................
(14d)
00
Tax ................................
15.
Balance of tax due (Subtract line 14(d) from line 13) ........................
(a)
(15a)
00
(b)
Interest ...........................
(15b)
00
(c)
Surcharges .....................
(15c)
00
(d)
Total (Add lines 15(a) through 15(c)) ...................................
00
(15d)
16.
Amount paid with this return ....................................................................................................................................................
(16)
00
17.
Amount overpaid to be credited to the special surtax for 2011 .......................................................................................................
00
(17)
18.
Prepayment of tollgate tax (Part IV, line 11) ..........................................................................................................................
(18)
00
19.
Tollgate tax applied against tax withheld attributable to current year distribution ................................................................................
00
(19)
20.
Total prepayment of tollgate tax liability (Add lines 18 and 19) .......................................................................................................
(20)
00
21.
Less:
a)
Current year estimated tollgate tax payments ..............................................................
(21a)
00
b)
Excess from previous years not included on line 21(a) .................................................
(21b)
00
c)
Amount paid with automatic extension of time or with original return ................................
(21c)
00
d)
Total (Add lines 21(a) through 21(c)) .........................................................................................................................
00
(21d)
22 .
Balance of tax due (Subtract line 21(d) from line 20) ........................
(a)
Tax ................................
(22a)
00
(b)
Interest ...........................
(22b)
00
(c)
(22c)
Surcharges .....................
00
(d)
00
Total (Add lines 22(a) through 22(c)) ..................................
(22d)
Amount paid with this return ....................................................................................................................................................
23.
00
(23)
24.
Amount overpaid to be credited to estimated prepayment of tollgate tax for 2011 ..............................................................................
00
(24)
Retention Period: Ten (10) years