Form Ft 1120fi - Corporation Franchise Tax Report For Financial Institutions - 2013

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FT 1120FI

Reset Form

Rev. 12/12

2013 Corporation Franchise Tax Report for Financial Institutions

Based upon calendar year 2012 or other taxable year beginning

and ending

, 2012.

If this is an amended report, check the box (if the amended report reﬂ ects a refund, attach form FT REF).

Ohio franchise tax I.D. number

Corporation name

Ohio charter or license number

Address (if address change, check box)

Federal employer I.D. number

City

State

ZIP code

North American Industry Classiﬁ cation System

(NAICS Code)

Statutory Agent

Corporate Ofﬁ cers

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

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

same as were reported on last year’s franchise tax report.

reported on last year’s franchise tax report.

President

Name

Secretary

Address

Treasurer

City, state, ZIP code

Instructions for this form are

Schedule A — Computation of Franchise Tax

Whole Dollars Only

on our Web site at tax.ohio.gov.

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 6) ............................................................................5.

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

7. Overpayment carryforward from 2012 .......................................................................................................7.

8. Estimated payments made in tax year 2013: E

, ER

, EX

........8.

9. Refundable credits (from Schedule A-2, line 5 and attach applicable credit certiﬁ cate) ...........................9.

10. Total payments and refundable credits (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. Because of the franchise tax phase-out, all overpayments will be refunded. If this is

an amended report, attach Ohio form FT REF ........................................................................................14.

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

Declaration/Signatures (an ofﬁ cer or managing agent of the corporation must sign this declaration)

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

its money or property for or in aid of or opposition to a political party, a candi-

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