Form 200-C - Delaware Composite Personal Income Tax Return - 2013
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1
2TAX YEAR
DELAWARE
Page 1
FORM 200-C
2013
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:
EMPLOYER IDENTIFICATION OR SOCIAL SECURITY NUMBER
NAME OF BUSINESS
ADDRESS
STATE
CITY
ZIP CODE
DELAWARE ADRESS (IF DIFFERENT)
STATE
ZIP CODE
CITY
NATURE OF BUSINESS
DATE OF INCORPORATION
STATE OF INCORPORATION
1. DELAWARE SOURCED INCOME (NON-RESIDENTS ONLY)...............................................................................................
1
2. TAX LIABILITY (MULTIPLY LINE 1 BY .0675)......................................................................................................................
2.
3.
NON REFUNDABLE CREDITS (MUST ATTACH FORM 700).................................................................................................
3.
BALANCE (SUBTRACT LINE 3 FROM LINE 2. CANNOT BE LESS THAN ZERO)....................................................................
4.
4.
5. ESTIMATED TAXES PAID (INCLUDE REAL ESTATE ESTIMATED TAXES PAID ON THIS LINE)....................................................
5.
6. IF LINE 5 IS LESS THAN LINE 4, SUBTRACT LINE 5 FROM LINE 4 AND ENTER HERE...................................... PAY IN FULL>
6.
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 EIN OR SSN
PREPARER’S PHONE
DATE
STREET ADDRESS OF PREPARER
CITY
STATE
ZIP
MAKE CHECK PAYABLE AND MAIL TO: DELAWARE DIVISION OF REVENUE, P.O. BOX 508, WILMINGTON, DE 19899-0508
*DF21313019999*
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