Louisiana Corporate Income Tax and Franchise Tax Returns

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LAGen Louisiana Corporate Income Tax and Franchise Tax Returns General Information LA LAGen (0) Louisiana revenue account number (xxxxxxx-xxx) Corporate address line 9 Initial return (If different from federal) Final return (If different from federal) (Franchise tax will be zero) Principal place of business: (If different from mailing address) Corporation is exempt from franchise taxable base ( = Yes, = No) Corporation is included in a federal consolidated return (C Corp) ( = Yes, = No) (If different from federal) FEIN of consolidated federal income tax return Corporation's books contain intercompany debt ( = Yes, = No) Real estate investment trust allowed dividends paid deduction General footnote Schedule A - Required Information Corporation at year end owns 0% or more of the stock of another corporation Anyone owning 0% or more of the corporation's voting stock at year end (C Corp) Corporation's income includes disregarded entity income Schedule N - Additional Information Required 7 9 0 Nature of the corporation's business in Louisiana (If different from federal business activity) Nature of the corporation's business elsewhere (If not nature of business in Louisiana) Parishes in which property is located Contributions Military family assistance fund: Income tax additional donation Franchise tax additional donation Contribution from net overpayment 0 7

LAEst Application of current year overpayment = Refund 00% of overpayment Louisiana Estimates Overpayment Application = Apply amount specified below to estimates until exhausted; refund excess LA LAEst (0) = Apply 00% of overpayment to next year's estimates; refund excess = Apply to first and second estimates; refund excess = Apply to first estimate; refund excess 7 = Apply 00% of overpayment to next year's estimates; no refund = Apply equally to each estimate; refund excess Amount for code # or # Income tax applied to franchise tax (Force) = Apply amount below Estimates Form CIFT-0ES - declaration for next year = Use current year liability; if less than $000 use zero = Use current year liability adjusted by amount below = Use amounts entered below, before overpayment 9 = Use amounts entered below (If applying overpayment, only use code 7 or ) = Use current year liability even if less than $000 Amount for code # Amounts for code #,#9 or next year estimates paid: st payment nd payment rd payment th payment Number of estimates desired Amount to round up each estimate 7 9 0 Amounts for Code # or #9 Next Year Estimates Paid Estimate year end date (If changed) 7

LAG Louisiana Liabilities and Capital Liabilities and Capital Enter amounts only if different from federal Screen L- LA LAG (0) Accounts payable Mortgages, notes and bonds payable in less than year Other current liabilities Federal income tax payable State tax payable City tax payable Loans from stockholders Due to subsidiaries and affiliates Mortgages, notes and bonds payable in year or more Other liabilities Reclassification surplus accounts Preferred stock (C Corp) Common stock Paid-in or capital surplus - common Paid-in or capital surplus - preferred (C Corp) Surplus reserves Earned surplus and undivided profits Excess reserves or undervalued assets 7 9 0 7 9 0 7 9 0

LAAdj Louisiana Adjustments Federal Income Tax Deduction Worksheet LA LAAdj (0) Adjustments to convert Louisiana net income to a federal basis Federal net income (Force) Federal creditable expenses (Force) Federal income tax liability (Force) Alternative minimum tax deduction (C Corp/Force) Federal environmental tax Federal income tax disaster relief credits 7 Franchise Tax Assessed value of real and personal property in the current year Schedule F - Additions Louisiana income tax Other additions Schedule F - Subtractions Dividends Interest Road home Louisiana depletion in excess of federal depletion IRC Section 0(C) expenses not deducted on federal return Other subtractions: Louisiana income tax refund Governmental subsidies for operating public transportation systems Dividends from national banking corporations and state banking corporations Hurricane recovery entity benefits Schedule D adjustment 7 9 0 7 Schedule M - Analysis of Earned Surplus Other increases in earned surplus Distributions: (If different from federal) Cash (Force) Stock (Force) Property (Force) Other decreases in earned surplus Louisiana adjustment (Force) 9 0

LANOL Louisiana Net Operating Loss Carryover Net Operating Loss LA LANOL (0) Preceding Tax Year Income (Loss) Federal Tax Refund, Credit or Adjustment 999 Prior Year (Income Offset) NOL Utilized 000 00 00 00 00 00 00 007 00 009 00 0 0 0 0 0 (If different from Form 9) 7 9 0 7 9 0 7 9 0 7 9 0 7 9 Net operating loss footnote Prior period federal tax refund applicable to loss carryforward 0

LAAlloc Louisiana Allocation Allocable Income Net rents and royalties from immovable or movable property Royalties from the use of patents, trademarks, etc Income from estates, trusts, and partnerships Income from construction, repair, etc Other allocable income Allocable expenses Total 7 9 0 Louisiana LA LAAlloc (0)

LAELF Louisiana Electronic Filing General Information LA7 LAELF (0) Suppress Louisiana electronic file when filing federal return or extension electronically Form R-C has already been signed and returned (Links to Setup > 0 Corporation > Louisiana) Signature date (If different from federal) ERO signature date (If different from return signature date or federal ERO signature date) Electronic funds withdrawal for balance due returns: Requested payment date (Mandatory if using the electronic funds withdrawal method) Amount of tax payment (Force) For amended returns: Electronic funds withdrawal for balance due returns: Requested payment date (Mandatory if using the electronic funds withdrawal method) Amount of tax payment (Force) Department of Revenue may discuss return with preparer ( = Yes, = No) (If different from federal) Name control 7 Calculated Value 9 Force 0 Extension Information Louisiana Department of Revenue mandates the electronic filing of extensions Form R-C has already been signed and returned (Links to Setup > 0 Corporation > Louisiana) Extension request filed online via Link Louisiana Online Extension Electronic funds withdrawal for extension: Requested payment date (Mandatory if using the electronic funds withdrawal method)

LAE Louisiana Income Reconciliation Schedule E Enter amounts only if different from federal Screen Mc or federal Screen Ms LA LAE (0) Louisiana income tax (Force) Excess of capital loss over gains Taxable income not recorded on books Depreciation Depletion Other expenses on books but not on return Homeowner's association exempt function expenses (C Corp) Income on books but not on return Homeowner's association exempt function income (C Corp) Depreciation Depletion Other deductions on return, not on books 7 9 0

LACr Louisiana Tax Credits Nonrefundable Credits, Exemptions, and Rebates LA0 LACr (0) Code 00 0 0 0 0 70 7 Premium tax Bone marrow Nonviolent offenders Qualified playgrounds Debt issuance Contributions to educational institutions Donations to public schools Donations of materials, equipment, advisors, instructors 99 Other 00 Atchafalaya trace 0 Previously unemployed 0 Recycling Basic skills training New jobs Refunds by utilities Eligible re-entrants 0 Neighborhood assistance Research and development Cane river heritage area LA community economic development Apprenticeship Ports of Louisiana investor 0 Ports of Louisiana import export cargo Motion picture investment 7 9 Research and development Historic structures Digital interactive media Motion picture resident Capital company LCDFI New markets Brownfields investor Motion picture infrastructure 0 Angel investor 99 00 0 0 99 Other Biomed/University research Tax equalization Manufacturing establishments Enterprise zone Other Description Income Tax Franchise Tax 9 0 7 9 7 0 9 0 7 0 9 7 0 9 0 7 9 9 70 0 7 7 7 7 7 7 77 7 7 7 Transferable, Nonrefundable Credits Transferable credits 79

LAPOA Louisiana Power of Attorney General Information LA LAPOA (0) Power of Attorney or Tax Information Authorization ( = R-700, = R-700, = Both) Representative and Appointee Information Representative name Name of firm (Form R-700 only) Representative address City, state, zip code Telephone number Fax number E-mail address Designation (Form R-700 only) 7 9 0 Request for representative to receive notices and communications (Form R-700 only) State issuing license (Form R-700 only) State license number (Form R-700 only) Tax Matters Information Tax matters details No power to: (Form R-700 only) Sign the return(s) for the above tax matters Execute agreement to suspend prescription of tax File a protest to a proposed assessment Execute offers in compromise or settlement Represent the taxpayer before the department Obtain a private letter ruling on taxpayer's behalf Other (Specify) 7 9 0 Fees Number of tax years or periods: Copies requested Certified copies requested Designation Information Family member relationship (Form R-700 only) Other (Form R-700 only)

LAAmend Explanation of changes Louisiana Amended Return General Information LA LAAmend (0) Amounts as Previously Reported Transfer original information Tax paid with (or after) original return Overpayment on original return Amended Amounts Delinquent filing penalty Delinquent payment penalty Interest Overpayment to be applied 7

LABank Louisiana Electronic Funds Withdrawal Account Information LA LABank (0) Name of financial institution Routing transit number Account number Type of account ( = Checking, = Savings) Non-US financial institution

LAPmt Louisiana Payments and Extension Payments LA LAPmt (0) Prior year overpayment Total, or Treat calculated amounts as paid Specific payments if unequal or not timely: st payment nd payment rd payment th payment th payment Paid with extension: (For page of return) Income tax Franchise tax Date Paid Amount Paid Check Number Date Paid Amount Paid Calculated Amount 7 9 0 7 9 0 7 Extension Louisiana Department of Revenue mandates the electronic filing of extensions Extended due date (For filing instructions, penalty and interest calculations) Balance due on extension (Force): Income tax Franchise tax 0 9

LAG Louisiana Franchise Taxable Base Schedule G- Enter amounts only if different from Screen BS LA LAG (0) Not subject to Schedule G-, lines through Capital Stock: Common stock Preferred stock (C Corp) Paid-in or capital surplus - common Paid-in or capital surplus - preferred (C Corp) Earned surplus and undivided profits Surplus reserves Excess reserves and undervalued assets Due to subsidiaries and affiliates (Do not net with receivables) Deposit liabilities to affiliates Accounts payable less than 0 days old Allowable deductions 7 9 0

LACr Louisiana Tax Credits, Page Refundable Tax Credits and Rebates LA7 LACr (0) Louisiana citizens insurance assessment paid Code 0F F F F F F 7F F 9F F F F F 7F F 70F 7F 7F 7F 0F Description Inventory tax Amount on Schedule RC (Force) Ad valorem natural gas Amount on Schedule RC (Force) Ad valorem offshore vessels Telephone company property Prison industry enhancement Urban revitalization Mentor-Protege Milk producers Technology commercialization Angel investor Musical and theatrical production Solar energy systems - non-leased School readiness child care provider School readiness business - supported child care School readiness fees and grants to resource Retention and modernization Conversion of vehicle to alternative fuel: Able to determine exact cost Electing not to determine exact cost Digital interactive media and software Leased solar energy systems Other refundable Carryover Income Tax 7 7 9 0 7 9 0 Franchise Tax 7 9 0 7 9 0 Transferable, Refundable Credits Transferable credits

LASepAcc Louisiana Separate Accounting Income LA LASepAcc (0) Gross receipts Returns and allowances Cost of goods sold Gross rents Gross royalties Income from estates, trusts, partnerships Income from construction, repair, etc Other income 7 Deductions Officer's compensation Salaries and wages Repairs Bad debts Rent Taxes Interest Contributions Depreciation - tax Depletion Advertising Pension and profit sharing Employee benefits Other deductions 9 0 7 9 0

LAOthCO Louisiana Other Carryovers Tax Year 0 Carryovers Enter amounts from 0 returns to be used in year 07, 0, and 09 Nonrefundable credits: Income tax Franchise tax Citizens insurance credit Refundable tax credits Exclusions and deductions Net operating loss LA9 LAOthCO (0)

LAPen Louisiana Penalties and Interest General Information LA0 LAPen (0) Date return filed (If different from original due date of return) Prior year franchise tax (For tax accrual only) Suppress penalties on return: Late interest Failure to file Failure to pay