DIVISION OF REVENUE AND TAXATION. For calendar year 2012, or tax year beginning. I Did the corporation s method of determining income

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1 DIVISIO RVU D TXTIO R C O W LT CO O W For calendar year 0, or tax year beginning R 0F-C P DS CO D ISL ORTR T R I S D I CI Income Tax Return of a Foreign Corporation F IC I L S L LT ISL R ORT T T 0, 0, 0, and ending See separate instructions T O F F I ame Please print or Check boxes if: umber, street, and room or suite no see instructions City or town, state and ZIP code, or country see instructions type Country of incorporation Foreign country under whose laws the income reported on this return is also subject to tax C Date incorporated province or state, and country the preceeding tax year? K If the corporation had an agent in the CI at any time during the tax year, enter: Type of agent ame ddress If, is taxpayer s trade or business within the CI solely the result of a section FIRPT sale or disposition? Did the corporation have a permanent establishment in the CI for purposes of any applicable tax treaty between the United States and a foreign country? If, enter the name of the foreign country: L Did the corporation have any transactions with related parties? G Check method of accounting: t any time during the tax year, was the corporation engaged in a trade or business in the CI? See instructions and enter the corporation s principal: Business activity code number Business activity Product or service Protective return J F Schedule - attached change from the preceeding tax year? If, attach a statement with an explanation Principal location of worldwide business mended return I Did the corporation s method of determining income D Location of corporation s primary books and records city, CI, check here Final return First post-merger return Did the corporation s method of accounting change from the preceeding tax year? If, attach a statement with an explanation B Initial return ame or address change Cash nter number of s attached ccrual te: dditional information is required on page Other specify Computation of Tax Due or Overpayment Tax from section, line, Tax from Section II, Schedule J, line, page Tax from Section III add lines and 0 on page Total tax dd lines through a a 0 overpayment credited to 0 b b 0 estimated tax payments c Less 0 refund applied for on c Combine lines a through c d j stimated tax penalty see instructions Check if 0 is attached mount owed If line j is smaller than the total of lines and, enter amount owed Overpayment If line j is larger than the total of lines and, enter amount overpaid mount of overpayment on line a resulting from tax deducted and withheld under Chapter insert from schedule w, line, page nter portion of line you want Credited to 0 estimated tax Refunded f Credit for tax paid on undistributed capital gains attach Credit for federal tax paid on fuels attach See instructions TIT Chapter paid or withheld at source add line, page, and amounts from s - and 0 attach s - and 0 Total payments dd lines d through i j a b Tax deposited with 00 i e g h Refundable credits from 00, line c, and, line c d e f g h i a b 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 Declaration of preparer other than taxpayer is based on all information of which preparer has any knowledge ay Revenue and Taxation discuss this return with the preparer shown below see instructions? Sign ere Date Paid Preparer s Use Only Preparer s name Preparer s Signature Firm s name Firm s address For Privacy ct and Paperwork Reduction ct tice, see instructions Title Date Check if self-employed PTI I Phone no 0F-C 0

2 0F-C 0 dditional Information continued from page Is the corporation a controlled foreign corporation? O Is the corporation a personal service corporation? W Q t the end of the tax year, did the corporation own, directly or indirectly, 0% or more of the voting stock of a CI corporation? See section c for rules of attribution If, attach a statement showing name and I of such CI corporation; percentage owned; and taxable income or loss before OL and special deductions of such CI corporation for the tax year ending with or within your tax year Is the corporation taking a position on this return that a US the United States, thereby causing a reduction of tax? If, the corporation is generally required to complete and attach See for exceptions te: Failure to disclose a treaty-based return position may result in a $0,000 penalty see section X During the tax year, did the corporation own any entity that was disregarded as an entity separate from its owner under Regulations sections 00- and 00-? If, attach a statement listing the name, country under whose laws the entity was organized, and I if any of each such entity Did a partnership allocate to the corporation a distributive share Y S nter the available OL carryover from prior tax years Do not reduce it by any deduction on page, line 0a $ of income from a directly owned partnership interest, any of which is CI or treated as CI by the partnership or the partner? T Is the corporation a subsidiary in a parent-subsidiary controlled group? If, attach Schedule P See instructions During the tax year, did the corporation own at least a 0% interest, directly or indirectly, in any foreign partnership? If, enter the parent corporation s: I ame If, attach a statement showing the name and identifying number Do not include any information already entered in item T nter percentage owned P nter tax-exempt interest received or accrued during the tax year see instructions $ R If the corporation has an OL for the tax year and is electing to forego the carryback period, check here t the end of the tax year, did any individual, partnership, corporation, estate, or trust own, directly or indirectly, 0% or more of the corporation s voting stock? See section c for rules of attribution V If, see instructions for required attachment as the corporation engaged in any transaction the results of which are subject to the arm s length standard under section and its regulations? as the corporation recognized any interbranch amounts? If, attach statement see instructions Z U Is the corporation a dealer under section? Did the corporation mark to market any securities or commodities other than in a dealer capacity? 0, Uncertain Tax Position Statement see instructions? If, complete and attach Schedule UTP the CI Do not report items properly withheld and reported on 0-S See instructions Include below only income from CI sources that is not properly withheld and reported on 0-S Report only items that a are not correctly withheld at source or b are not correctly reported on 0-S The rate of tax on each item of gross e allowed against these types of income nter treaty rates where applicable If the corporation is claiming a lower treaty rate, also complete item W above If multiple treaty rates apply to a type of income eg, subsidiary and portfolio dividends or dividends received by disregarded entities, attach a statement showing the amounts, tax rates, and withholding for each ame of treaty country, if any a Class of income see instructions nnuities Interest b Gross amount Dividends Rents Royalties Gains from disposal of timber, coal, or domestic iron ore with a retained economic interest attach supporting statement Gains from sale or exchange of patents, copyrights, etc c Rate of tax % e mount of CI income tax paid or withheld at the source d mount of tax liability Fiduciary distributions attach supporting statement Gross transportation income attach Schedule V 0 Total nter here and on page, line Total nter here and include on page, line i ve? If, attach a statement that provides the information requested above with respect to each such item of income 0F-C 0

3 0F-C 0 SCTIO II - Income ffectively Connected with the Conduct of a Trade or Business in the CI see instructions Deductions See instructions for limitations on deductions Income Important: Fill in all applicable lines and schedules If you need more space, see ssembling the Return in the instructions a Gross receipts or sales b Less returns and allowances c Bal c Cost of goods sold from -, line attach - Dividends Schedule C, line Interest Gross rents Gross royalties Capital gain net income attach Schedule D 0 et gain or loss from, Part II, line attach 0 Other income see instructions attach schedule 0 Total income dd lines through 0 see instructions attach - Salaries and wages less employment credits Repairs and maintenance Bad debts for bad debts over $00,000, attach a list of debtors and amounts Rents Taxes and licenses Interest expense from Schedule I, line see instructions Charitable contribution c Depreciation from not claimed on - or elsewhere on return attach Depletion dvertising Domestic production activities deduction attach 0 Deductions allocated and apportioned to CI from Schedule, line 0 see instructions Other deductions attach schedule Total deductions dd lines through Taxable income before OL deduction and special deductions subtract line from line 0a Less: a et operating loss deduction see instructions b Special deductions Schedule C, line c dd lines 0a and 0b Taxable income or loss Subtract line 0c from line 0b 0F-C 0

4 0F-C 0 continued Schedule C Dividends and Special Deductions see instructions a Dividends received Dividends from less-than-0%-owned domestic corporations other than Dividends from 0%-or-more-owned domestic corporations other than see instructions Dividends on certain preferred stock of less-than-0%-owned public utilities Dividends on certain preferred stock of 0%-or-more-owned public utilities Dividends from less-than-0%-owned foreign corporations Dividends from 0%-or-more-owned foreign corporations Total dd lines through See instructions for limitation Dividends from foreign corporations not included on lines,, or Foreign dividend gross-up section IC-DISC and former DISC dividends not included on lines,, or section d Deduction for dividends paid on certain preferred stock of public utilities Total dividends dd lines through nter here and on line, page Total special deductions dd lines and nter here and on page, line 0b Other dividends 0 0 Check if the corporation is a member of a controlled group attach Schedule O 0 Income tax C heck if a qualified personal s ervice corporation see ins tructions lternative minimum tax attach dd lines and Schedule J Tax Computation see instructions a Foreign tax credit attach b General business credit attach 00 c Credit for prior year minimum tax attach d Bond credits from Total credits dd lines a through d S ubtract line from line Other taxes Check if from: c Special deductions: a x b b % c d 0 Total tax dd lines and nter here and on page, line a b Other attach statement 0F-C 0

5 0F-C 0 see instructions nter the amount from S ection II, line nter total adjustments to line to get effectively connected earnings and profits ttach required statement s howing the nature and amount of adjus tments S ee instructions connected earnings and p and line a nter CI net equity at the end of the current tax year ttach required statement b nter CI net equity at the end of the prior tax year ttach required statement c Increase in CI net equity If line a is greater than or equal to line b, subtract line b from line a nter the result here and skip to line e d Decrease in CI net equity If line b is greater than line a, subtract line a from line b a b c d e e Dividend equivalent amount Subtract line c from line If zero or less, enter -0- If no amount is entered on line c, add the less er of line d or line e to line and enter the total here otherwise qualifies for treaty benefits nter here and include on page, line see instructions lso complete item W on page equivalent amounts for thos e tax years Part II Tax on xcess Interest a b nter the inverse of the total amount deferred, capitalized, and disallowed from Schedule I, line d ie, if line d is negative, enter as a positive number; if line d is positive, enter as a negative number c C ombine lines a and b amount mus t equal S chedule I, line b Branch Interest If the interest paid by the foreign corporation s CI trade or business was increased because 0% or more of the foreign corporation's assets are CI assets, check this box a xcess interest S ubtract line from line c If zero or less, enter -0-0 see instructions for this Part and for Schedule I 0F a nter the interest from S ection II, line c a b If the foreign corporation is a bank, enter the excess interest treated as interest on deposits Otherwise, enter -0- S ee ins tructions c S ubtract line b from line a b Tax on excess interest otherwise qualifies for treaty benefits nter here and include on page, line see instructions lso complete item W on page c 0 Part III dditional Information a complete termination of all CI trade or businesses? b The tax-free liquidation or reorganization of a foreign corporation? c The tax-free incorporation of a CI trade or business? If a or b applies and the transferee is a domestic corporation, attach If c applies, attach the statement required by Temporary Regulations section -Td 0F-C 0

6 0F-C 0 te: Check if completing on Schedule L CI basis or Balance Sheets per Books Beginning of tax year ssets a a Trade notes and accounts receivable b Less allowance for bad debts Inventories CI government obligations C as h a Other loans and investments non-ci ass ets* b Other loans and investments CI assets* 0a Buildings and other depreciable assets b Less accumulated depreciation ortgage and real es tate loans a Depletable as s ets b Less accumulated depletion Land net of any amortization a Intangible assets amortizable only b Less accumulated amortization s s ets held in trus t a Other non-current non-ci assets* b Other non-current CI assets Total as sets Liabilities ortgages, notes, bonds payable in less than year: a Interbranch liabilities* liabilities * b Third-party current Other liabilities* 0 ortgages, notes, bonds payable in year or more: a Interbranch liabilities* b Third-party liabilities * Liabilities held in trus t cc ounts payable c d Other non-current interbranch assets* nd of tax year b Tax-exempt securities see instructions a Interbranch current assets* b Other current non-ci assets c Other current CI assets Loans to shareholders Worldwide basis Loans from s hareholders a Other interbranch liabilities* b Other third-party liabilities * quity 0 a P referred stock b C ommon s tock dditional paid-in capital R etained earnings ppropriated* Retained earnings Unappropriated djustments to shareholders equity* Less cos t of treasury stock Total liabilities and shareholders equity Capital stock: *ttach schedule See instructions 0F-C 0

7 0-F 0 Schedule W Overpayment Resulting From Tax Deducted and Withheld Under Chapter Total Chapter payments nter the amount from page, line i nter the tax amount from page, line nter the portion of the tax amount shown on page, line pertaining to income associated with amounts deducted and withheld under sections and see instructions for general guidelines Total Chapter tax Combine lines and Tentative overpayment resulting from tax deducted and withheld under Chapter Subtract line from line nter the amount from page, line a Overpayment resulting from tax deducted and withheld under Chapter nter the smaller of line or line nter the result here and on page, line b 0-F 0

8 LT ORTR T R I I C P DS D ISL R O W LT R CO S D ISL DIVISIO RVU D TXTIO R CO O W ORT T F IC I L S L PPLICTIO FOR RBT O CI SOURC ICO TX OS-0 FOR US WIT FOR 0F-C See instructions on reverse side TI T O F F I 0 Contact person Telephone number ailing ddress Do not write in this space Corporate ame Please type or print in ink T PRT - O-RFUDBL CRDITS Business gross revenue tax ame Tax ID a a b b User fees paid Fees and taxes imposed under CC 0h see instructions Total non-refundable credits add lines through PRT B - RBT COPUTTIO Total TIT Total TIT payments made Total non-refundable credits enter amount from line, PRT Rebate offset base subtract line from line If zero or less, enter -0- TIT overpayment If line is greater than line, subtract line from line Otherwise enter -0-0 TIT underpayment If line is greater than line, subtract line from line Otherwise enter -0 Rebate offset amount see instructions on reverse side 0 PRT C - CPTR TX DJUSTT See supplemental of instructions Tax underpaid before rebate offset nter amount from line 0 above Tax overpaid before rebate offset nter amount from line above Rebate offset amount nter the amount from line above Late charges nter all applicable late charges here lso include estimated tax penalty see instructions Check if 0 is attached Tax on overpayment of credit nter the lesser of line of ths Part or the total of lines g and h as shown on page of 0F-C Total due or overpaid dd lines through of this part If this line shows amount due, pay this amount Stop here through mount you want credited to your 0 STITD TX mount on line you want credited to your 0 BUSISS GROSS RVU TX Indicate month et overpayment Subtract the total of lines and from line PRT D - BUSISS GROSS RVU TX CRDIT LLOCTIO nter the TI and amount you want credited from page Part, line The total credit allocation shall be equal to the amount on page Part, line TI OUT Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete Declaration of preparer other than taxpayer is based on all information of which preparer has any knowledge SIG R Title Print/Type Preparer s name PID PRPRR S US OLY Date Preparer s Signature Date Firm s name Firm s address Check if self-employed Preparer s social security no I Telephone no FOR FICIL US OLY DT PID *If received after the due date, show post mark OUT PID RCIPT O VRIFID BY POSTD BY OS-0 0

9 0 OS-0 ISTRUCTIOS for 0F-C General ame and address Fill in name and address PRT O-RFUDBL CRDITS nter the amount of business gross revenue tax paid or accrued during the taxable year under CC Chapter For partners and/ or the equity, whichever is applicable If you have more than one business name, list each one separately with its respective TI and amount of BGRT This is the tax imposed under CC 0 nter the amount of user fees paid during the taxable year under CC nter the amount of fees and taxes paid or accrued during the taxable year under CC 0h, in lieu of the tax imposed under CC 0 dd all amounts shown in lines through PRT B RBT COPUTTIO 0 nter the tax from 0F-C, page line nter the total payments made for the taxable year from 0F-C, page, line j nter the total non-refundable credits from part, line above Rebate offset base Subtract line from line If zero or less, enter zero If line is greater than line, subtract line from line Otherwise enter zero If line is greater than line, subtract line from line Otherwise enter zero Compute the amount on line as shown on the rebate table below PRT C - CPTR TX DJUSTT Tax underpaid before rebate offset nter amount from line 0 above Tax overpaid before rebate offset nter amount from line above Rebate offset amount nter the amount from line above Late charges nter all applicable late charges here lso include estimated tax penalty For purposes of estimated tax penalty 0, the tax for 0 is the amount shown on Part B, line above Tax on overpayment of credit nter the lesser of line ignore bracket of this Part or the total of lines g and h as shown on 0F-C, page If zero or less, enter -0 Total due or overpaid dd lines through of this part If this line shows amount due, pay this amount Stop here If line is an overpayment, enter amount you want credited to your 0 estimated tax If line is an overpayment, enter amount you want credited to your 0 BUSISS GROSS RVU TX Indicate the month to be credited et overpayment dd lines,, and RBT TBL IF RBT FST BS line IS: T RBT FST OUT IS: XPL: t over $0,000 0% of the rebate offset base Rebate offset base x 0% $0,000-$00,000 $,000 plus 0% of the rebate offset base over $0,000 Rebate offset base - 0,000 x 0% +,000 Over $00,000 $,000 plus 0% of the rebate offset base over $00,000 Rebate offset base - 00,000 x 0% +,000 PRT D BUSISS GROSS RVU TX CRDIT LLOCTIO nter the Taxpayer Identification umber TI and amount to be allocated The total credit allocation shall be equal to the amount on line, Part C DIVISIO RVU D TXTIO POST FIC BOX CRB SIP, P 0 OS-0 0