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Michigan Dept. of Treasury
2002
(Revised 8-02)
2002 MICHIGAN
C-8000KC
SBT Schedule of Shareholders and Officers
For all corporations claiming statutory exemption or small business credit.
This form is issued under authority of P.A. 228 of 1975. See instruction booklet for filing guidelines.
1. Name
2. Federal Employer ID No. (FEIN) or TR No.
PART 1: SHAREHOLDERS AND OFFICERS
- See instruction booklet
3A.
Shareholder (including corporation and
B.
Social Security
C.
If an officer,
D.
% Time
E.
% Stock
F.
% Stock with
G.
% Stock from col. F less
trust) or officer name (Last, First, Initial)
Number
check here.
attribution
any attribution between 2
active shareholders
a.
a.
b.
b.
c.
c.
d.
d.
e.
e.
f.
f.
g.
g.
h.
h.
F
%
% of stock (not listed above) owned by shareholders who own less than 20% and receive no compensation.
100%
Total
Continue below using same a through h references.
H.
Dividends
I.
Salaries, wages
J.
Employee insurance
K.
Total compensation and
L.
Share of business
M.
Total shareholder/
-used to determine
and/or director fees
plans, pensions, etc.
director fees for officers
income/loss
officer income
active shareholders
and/or shareholders
-Form C-8000C,
-add columns K & L.
-add columns I & J
line 6 x column G.
a.
a.
b.
b.
c.
c.
d.
d.
e.
e.
f.
f.
g.
g.
h.
h.
If more space is needed attach additional C-8000KC forms. Identify each additional form and complete Part 1.
PART 2: STATUTORY EXEMPTION
- See definition of qualified shareholder in the instruction booklet.
4.
Qualified shareholders. Add the number of qualified shareholders from Part 1.
Enter here and on C-8043, line 8a
4.
5.
Compensation and director fees of ALL shareholders. Add amounts in column K for each
shareholder showing ownership in column E. Enter here and on C-8043, line 5
.00
5.
PART 3: SMALL BUSINESS CREDIT
- See definition of active shareholder in the instruction booklet.
6.
Compensation and director fees of active shareholders. Add amounts in column K for each
.00
active shareholder. Enter here and on C-8000C, line 7 or C-8044, line 12
6.
7.
Compensation and director fees of officers. Add amounts in column K for each officer who
.00
is not an active shareholder. Enter here and on C-8000C, line 8 or C-8044, line 12
7.