Tennessee Franchise and Excise Tax Return

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TNGen Tennessee Franchise and Excise Tax Return General Information TN TNGen (0) Account number Type of structure = Foreign corporation = Single member LLC/corporation = PLLC = LLC = Series LLC = Other Other (specify) Initial return (If different from federal) Inactive in Tennessee Final Tennessee return (If different from federal) Application of Public Law 8- to excise tax Date Tennessee operations began (If different from date of incorporation) Use paid preparer and do not want forms mailed next year Taxpayer's signature gives preparer power of attorney General footnote 8 0

TNCO Tennessee Net Operating Loss and Credit Carryover Net Operating Loss Carryover TN TNCO (0) Preceding Tax Year 000 00 00 00 00 00 00 00 008 00 00 0 0 0 0 Income (Loss) 8 0 8 0 8 0 Prior Year (Income Offset) NOL Utilized Net operating loss footnote Machinery Credit Carryover Preceding Tax Year 000 00 00 00 00 00 00 00 008 00 00 0 0 0 0 For Original Return or As Amended 8 0 8 0 8 0 Used in Prior Year(s)

TNELF Tennessee Electronic Filing General Information TN TNELF (0) Suppress Tennessee electronic file when filing federal return or extension electronically Suppress return and extension electronic files when only filing estimates electronically Signature date (If different from federal) Electronic funds withdrawal for balance due returns: Requested payment date (Mandatory if using the electronic funds withdrawal method) For amended returns: Electronic funds withdrawal for balance due returns: Requested payment date (Mandatory if using the electronic funds withdrawal method) Electronic funds withdrawal for extension: Requested payment date (Mandatory if using the electronic funds withdrawal method) Name control Estimate Information Calculated Value Force 8 Suppress electronic file(s) for estimates (For voucher amounts greater than zero) Electronic funds withdrawal for estimated payments: st payment nd payment rd payment th payment Create Electronic File 0 Withdrawal Date (If different from due date)

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

TNCr Tennessee Credits Credits TN TNCr (0) Gross premiums tax credit Tennessee income tax credit Green energy tax credit (Form FAE 0) Carbon charge tax credit (Form FAE 0) Brownfield property credit (Form FAE 0) Community investment credit (Form FAE ) Tennessee rural opportunity fund credit (Form FAE ) Tennessee small business opportunity fund credit (Form FAE ) Qualified headquarters relocation expense credit Jobs tax credit (Schedule X, Line ) Additional jobs tax credit (Schedule X, Line ) 8 0 Industrial Machinery Tax Credit Purchase price of industrial machinery Recapture of franchise and excise tax credit

TNAlloc Tennessee Nonbusiness Income Allocation of Nonbusiness Income TN TNAlloc (0) Total Tennessee Nonbusiness earnings

TNInt Tennessee Intangible Expense General Information TN8 TNInt (0) Application for approval to deduct intangible expenses = Form IE-A previously submitted, approval/denial pending = Form IE-A previously submitted and approved Name of affiliate FEIN of affiliate Federal form: Number Expense deducted on line number Type of expense Intangible Expense Expense paid to affiliate in a foreign nation that is a signatory to a comprehensive income tax treaty: Foreign Nation Deduction 8 Expense paid to an affiliate when the affiliate paid in the same tax year a portion to an entity that is not an affiliate Name of non-affiliate FEIN of non-affiliate 0 Deduction Expense paid to affiliate doing business in a state that imposes a tax measured by net income

TNFIGen Tennessee Financial Institution and Captive REIT Tax Return General Information TN TNFIGen (0) Return type ( = Financial institution, = Captive REIT)

TNFIAdj Tennessee Financial Additions and Deductions Additions to Federal Net Income TN0 TNFIAdj (0) Captive REIT dividends paid deduction Deductions from Federal Net Income Bad debts not deducted but allowed

TNAmend Explanation of changes Tennessee Amended Return General Information TN TNAmend (0) Amounts as Previously Reported Transfer original information Tax paid with (or after) original return Overpayment on original return Amended Amounts Penalty Interest Penalty on estimated franchise, excise tax payments Interest on estimated franchise, excise tax payments Overpayment to be applied 8

TNEst Tennessee Estimates Overpayment Application TN TNEst (0) Application of current year overpayment = Refund 00% of overpayment = Apply 00% of overpayment to next year's estimates; refund excess = Apply to first estimate; refund excess = Apply amount specified below to estimates until exhausted; refund excess = Apply to first and second estimates; refund excess = Apply 00% of overpayment to next year's estimates; no refund = Apply equally to each estimate; refund excess Amount for code # or #8 8 = Apply amount below Estimates Form FAE - declaration for next year = Use current year liability; if less than $,000 use zero = Use current year liability adjusted by the amount below = Use amounts entered below, before overpayment = Use amounts entered below (if applying overpayment, only use code or 8) = Use current year liability even if less than $,000 Amount for code # Amounts for code #, # or next year estimates paid: st payment nd payment rd payment th payment Number of estimates desired Amount to round up each estimate 8 Amounts for Code # or # 0 Next Year Estimates Paid

TNPen Tennessee Penalties and Interest General Information TN TNPen (0) Date return filed (If different from original due date of the return) Prior year franchise tax Prior year excise tax Prior year number of months (If not ) Suppress penalties on return: Underpayment of estimated tax Late interest Failure to file or failure to pay

TNPmt Tennessee Payments and Extension Payments TN TNPmt (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 the return) Date Paid Amount Paid Calculated Amount 8 0 8 Extension Calculate extension payment = Use 00% of current year liability = Use 0% of current year liability = Use 00% of prior year liability Extended due date (For filing instructions, penalties and interest calculations) Estimated franchise tax (Force) Estimated excise tax (Force) Balance due on extension (Force) 0

TNAdj Tennessee Franchise and Property Net Worth TN TNAdj (0) Indebtedness to or guaranteed by parent or affiliated corporation Consolidated net worth (Net worth calculated per Code Section --0(g)-(i)) Determination of Real and Tangible Property *Enter information only if different from View > Apportionment Book Value of Property Owned: Land * Buildings, leaseholds, and improvements * Machinery, equipment, furniture, and fixtures * Automobiles and trucks * Prepaid supplies and other tangible personal property * Share of partnership real and tangible property * Inventories and work in progress * Exempt inventory (Finished goods in excess of $0,000,000) * Value of certified pollution control equipment Exempt required capital investments 8 0 In Tennessee Net Annual Rental Paid for: Real property Machinery and equipment Furniture Delivery or mobile equipment * * * *

TNBD Tennessee Bankruptcy Discharge Bankruptcy Discharge TN TNBD (0) Date of discharge Amount of discharge

TNPOA Tennessee Power of Attorney Representative Information TN8 TNPOA (0) Representative name Representative address City, state, zip code Telephone number Fax number Designation Other designation Jurisdiction 0 Tax Matters Information Type of tax Year(s) or period(s) Type of tax Year(s) or period(s) Type of tax Year(s) or period(s)

TNUGen EIN Member's name Tennessee Unitary Combined Return Group Information TNUGen (0) Unit TN Consolidated net worth (Net worth calculated per Code Section --0(g)-(i)) Receipts of non-unitary members of the financial institution affiliated group Expenses from transactions between members Dividends and receipts from transactions between members Member Information Account number Non-consolidated net worth Indebtedness to or guaranteed by parent or affiliated corporation Account period 8

TNAdj Tennessee Additions and Deductions Computation of Net Earnings TN0 TNAdj (0) Income items (S Corp/Force) Net loss or expense received from a pass-through Expense items (S Corp/Force) Net gain or income received from a pass-through Additions to Federal Net Income Intangible expense paid to an affiliated business entity deducted for federal tax purposes Safe Harbor lease election expenses or depreciation deducted Gain on sale of an asset sold within months of distributions (S Corp) Tennessee excise tax deducted on federal return Interest income on obligations of states and their political subdivisions Depletion not based on actual recovery of cost Excess fair market value over book value of property donated Excess rent paid, accrued, or incurred for property owned by an affiliate 8 0 Deductions from Federal Net Income Loss on sale of an asset sold within months after distributions (S Corp) Dividends received from corporations, at least 80% owned Donations to qualified public school support groups and nonprofit organizations Expenses not deducted on federal return for which a federal tax credit is allowable Income and depreciation deductions due to Safe Harbor lease election Income from affiliated entity if corresponding intangible expenses have not been deducted 0

TNUPmt EIN Member's name Tennessee Member's Payments Member's Payments TNUPmt (0) Unit TN Prior year overpayment Total, or st payment nd payment rd payment th payment th payment Paid with extension 8 0

TNUProp Tennessee Member's Real and Tangible Property EIN Member's name Determination of Real and Tangible Property TNUProp (0) Unit TN Book Value of Property Owned: Land Buildings, leaseholds, and improvements Machinery, equipment, furniture, and fixtures Automobiles and trucks Prepaid supplies and other tangible personal property Share of partnership real and tangible property Inventories and work in progress Exempt inventory (Finished goods in excess of $0,000,000) Value of certified pollution control equipment Exempt required capital investments Net Annual Rental Paid for: Real property Machinery and equipment Rental for furniture Delivery or mobile equipment 8 0 In Tennessee

TNUInc Tennessee Member's Computation of Earnings EIN Member's name Schedule H Gross Receipts Unit TN TNUInc (0) Gross receipts or sales per federal income tax return Schedule J- Partnerships Partnership ordinary income or loss Additional income specifically allocated to partners Net loss or expense received from a pass-through Additional expenses specifically allocated to partners Amount subject to self-employment taxes Contributions to qualified pension or benefit plans Net gain or income received from a pass-through 8 0 Schedule J- Single Member LLCs Business income from Form 00: Schedule C Schedule D Schedule E Schedule F Form Other business income Net loss or expense received from a pass-through Amount subject to self-employment taxes Net gain or income received from a pass-through Form Schedule 8 0 Schedule J- S Corporations S corporation ordinary income or loss Income items Net loss or expense received from a pass-through Expense items Net gain or income received from a pass-through Schedule J- Corporations and Other Entities Form 0 income or loss Form 0-T unrelated business taxable income Other business income Net loss or expense received from a pass-through Net gain or income received from a pass-through Form Schedule 8 0

TNUAdj Tennessee Member's Additions and Deductions EIN Member's name Additions to Federal Net Income Unit TN TNUAdj (0) Intangible expense paid to an affiliated business entity deducted for federal tax purposes Safe Harbor lease election expenses or depreciation deducted Deduction for domestic production activities Gain on sale of an asset sold within months of distributions Tennessee excise tax deducted on federal return Interest income on obligations of states and their political subdivisions Depletion not based on actual recovery of cost Contribution carryover from prior period(s) Capital gains offset by capital loss carryover or carryback Excess fair market value over book value of property donated Excess rent paid, accrued, or incurred for property owned by an affiliate Captive REIT dividends paid deduction 8 0 Deductions from Federal Net Income Loss on sale of an asset sold within months after distributions Dividends received from corporations, at least 80% owned Contributions in excess of amount allowed by federal government Donations to qualified public school support groups and nonprofit organizations Capital loss not included in federal taxable income Expenses not deducted on federal return for which a federal tax credit is allowable Income and depreciation deductions due to Safe Harbor lease election Income from affiliated entity if corresponding intangible expenses have not been deducted Bad debts not deducted but allowed 8 0 8

TNUAlloc Nonbusiness earnings Tennessee Member's Nonbusiness Income EIN Member's name Allocation of Nonbusiness Income Total TNUAlloc (0) Unit Tennessee TN

TNUInt Tennessee Member's Intangible Expense EIN Affiliate's name General Information Unit TN TNUInt (0) Application for approval to deduct intangible expenses = Form IE-A previously submitted, approval/denial pending = Form IE-A previously submitted and approved Federal form: Number Expense deducted on line number Type of expense 8 Intangible Expense Expense paid to affiliate in a foreign nation that is a signatory to a comprehensive income tax treaty: Foreign Nation 0 Deduction Expense paid to an affiliate when the affiliate paid in the same tax year a portion to an entity that is not an affiliate Name of non-affiliate FEIN of non-affiliate Deduction Expense paid to affiliate doing business in a state that imposes a tax measured by net income

TNUAppt Tennessee Member's Financial Institution Apportionment EIN Member's name Receipts Ratio TNUAppt (0) Unit TN Receipts from leases of real property Interest income and other receipts from loans or installment sales Interest income and other receipts from consumer loans Interest income and receipts from commercial and installment loans Receipts and fee income from letters of credits Interest income, merchant discount, and other receipts Sales of an intangible or tangible asset Receipts from fiduciary and other services Receipts from travelers checks, money orders and US savings bonds Interest income and other receipts from participation loans Other business receipts Tennessee 8 0 8 0 Everywhere

TNUAppt Tennessee Member's Captive REIT Apportionment EIN Member's name Property Factor TNUAppt (0) Unit TN8 Land, buildings, leaseholds, and improvements - BOY Land, buildings, leaseholds, and improvements - EOY Machinery, equipment, furniture, and fixtures - BOY Machinery, equipment, furniture, and fixtures - EOY Automobiles and trucks - BOY Automobiles and trucks - EOY Inventories and work in progress - BOY Inventories and work in progress - EOY Prepaid supplies and other property - BOY Prepaid supplies and other property - EOY Share of partnership property - BOY Share of partnership property - EOY Rented property (Rent paid X 8) Tennessee 8 0 8 0 8 Everywhere Payroll Factor Payroll Sales Factor Sales Tennessee 0 Tennessee Everywhere Everywhere

TNUDepr Tennessee Member's Depreciation Adjustments EIN Member's name Adjustments for State Differences in Depreciation TNUDepr (0) Unit TN Depreciation and disposition adjustments Federal depreciation with bonus depreciation State depreciation without bonus depreciation Depreciation disposition adjustment Calculated Amount

TNUCr EIN Member's name Tennessee Member's Credits Group Credits Unit TN0 TNUCr (0) Jobs tax credit (Schedule X, Line ) Additional jobs tax credit (Schedule X, Line ) Member Credits Gross premiums tax credit Tennessee income tax credit Community investment credit Tennessee rural opportunity fund credit Tennessee small business opportunity fund credit Qualified headquarters relocation expense credit 8 0 Industrial Machinery Tax Credit Purchase price of industrial machinery Recapture of franchise and excise tax credit

TNUCO Tennessee Member's Net Operating Loss and Credit Carryover EIN Member's name Net Operating Loss Carryover Unit TN TNUCO (0) Preceding Tax Year 000 00 00 00 00 00 00 00 008 00 00 0 0 0 0 Income (Loss) 8 0 8 0 8 0 Prior Year (Income Offset) NOL Utilized Machinery Credit Carryover Preceding Tax Year 000 00 00 00 00 00 00 00 008 00 00 0 0 0 0 For Original Return or As Amended 8 0 8 0 8 0 Used in Prior Year(s)