Form Ft 1120fi - Corporation Franchise Tax Report For Financial Institutions

Mail with remittance to: Ohio Department of Taxation, P.O. Box 27, Columbus, Ohio 43216-0027

Tax Year

FT 1120FI

OHIO

2005

Corporation Franchise Tax Report for Financial Institutions

EPARTMENT

NLY

2004

Based upon calendar year 2004 or other taxable year beginning ____________________, _____ and ending ____________________,

If this is an amended report, check the box (if the amended report reflects a refund, attach Form FT REF).

Ohio franchise tax I.D. number

—

Corporation name

This field MUST be completed.

Ohio charter or license number

Address (check box if you are not receiving forms at the proper mailing address)

Federal employer I.D. number

This field MUST be completed.

City

State

ZIP code

North American Industry Classification System

(NAICS Code)

Statutory Agent

Corporate Officers

Check the box if both the below-reported statutory agent and address are the

Check the box if all the below-reported corporate officers are the same as were

same as were reported on the 2004 franchise tax report.

reported on the 2004 franchise tax report.

President

Name

Secretary

Address

Treasurer

City

State

ZIP code

Schedule A — Computation of Franchise Tax

Instructions for this form are on our web site at

Whole Dollars Only

1. Net value of stock (from Schedule E, line 7 or, if applicable, from Schedule F, line 6) ..........................

1. ___________________

2. Apportionment ratio (from Schedule D-1, line 4 or Schedule D-2) ........................................................

2. ___________________

3. Taxable value (line 1 x line 2) ..................................................................................................................

3. ___________________

4. Tax on net worth basis (.013 x line 3, but not less than the minimum fee) ............................................

4. ___________________

5. Total nonrefundable credits (from Schedule A-1, line 7) ........................................................................

5. ___________________

6. Amount due after nonrefundable credits (line 4 minus line 5, but not less than the minimum fee) .....

6. ___________________

7. Overpayment carryforward from 2004 .....................................................................................................

7. ___________________

8. Estimated payments made in tax year 2005: E __________, ER __________, EX __________ .....

8. ___________________

9. Refundable credits ..................................................................................................................................

9. ___________________

10. Total payments and refundable credits (add lines 7, 8 and 9) ............................................................... 10. ___________________

11. Tax due (line 6 minus line 10) ................................................................................................................. 11. ___________________

12. Interest __________, Penalty __________, Total interest and penalty ............................................... 12. ___________________

13. Balance due (make payable to Ohio Treasurer of State). Check box if payment made by EFT

...... 13. ___________________

14. Overpayment ........................................................................................................................................... 14. ___________________

15. Amount of line 14 to be credited to tax year 2006 estimated tax (if an amended report, enter -0-) ....... 15. ___________________

16. Amount of line 14 to be refunded (if an amended report, attach form FT REF) ..................................... 16.

Declaration/Signatures (An officer or managing agent of the corporation must sign this declaration. )

I declare under penalties of perjury that this report (including any accompa-

or use any of its money or property for or in aid of or opposition to a political

nying schedule or statement) has been examined by me and to the best of

party, a candidate for election or nomination to public office, or a political

my knowledge and belief is a true, correct and complete return and report

action committee, legislation campaign fund, or organization that supports

and that this corporation has not, during the preceding year, except as

or opposes any such candidate or in any manner used any of its money for

permitted by section 3517.082, 3599.03 and 3599.031 of the Ohio Revised