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4 State of Rhode Island Division of Taxation 4
5 RI-1065PA 5
6 Partnership Adjustment - Federal Imputed Assessment 20113999990101 6
7 7
8 8
Federal employer identification number Social security number
9 9
10 999999999 999999999 10
11 For the taxable year from 11
12 MM/DD/YYYY01/01/2018 through 12/31/2018MM/DD/YYYY Address Amended 12
13 Final determination date Change Return 13
14 MM/DD/YYYY05/25/2020 14
15 Name 15
16 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 16
17 Address 1 17
18 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 18
19 Address 2 NAICS code 19
20 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 99999999999 20
21 City, town or post office State ZIP code Email address 21
22 XXXXXXXXXXXXXXXXXXXXXXXXXX XX 99999 XXXXXXXXXXXXXXXXXXXXXXXXX 22
23 Entity Column A Column B 23
24 LLC LLP LP Partnership C Corporations Sub S Corps, Individuals, 24
type: LLCs, Partnerships & Trusts
25 25
1 Enter your net Rhode Island adjustments................................................................ 1a 1b
26 999999999 99 999999999 99 26
27 27
2 Enter the nonapportionable or allocable amounts included in line 1........................ 2a 2b
28 999999999 99 999999999 99 28
29 29
3 Subtract line 2 from line 1. This is the amount subject to apportionment................. 3a 3b
30 999999999 99 999999999 99 30
31 31
4 Enter the Rhode Island apportionment ratio. Carry to six (6) decimal places......... 4a 4b
32 _ . _ _ _ _ _ _0.999999 _ . _ _ _ _ _ _0.99999932
33 33
5 Multiply the amount on line 3 by the ratio on line 4. Enter the result here............... 5a 5b
34 999999999 99 999999999 99 34
35 35
6 Enter the portion of line 2 allocated to Rhode Island............................................... 6a 6b
36 999999999 99 999999999 99 36
37 37
7 Add lines 5 and 6. Enter the total. If zero or less, enter “0”...................................... 7a 7b
38 999999999 99 999999999 99 38
39 39
40 8 Rhode Island tax rate............................................................................................... 8a 7.00% 8b 5.99% 40
41 41
9 Rhode Island Tax Due. Multiply the amount on line 7 by the applicable tax rate 9a 9b
42 on line 8................................................................................................................ 999999999 99 999999999 99 42
43 43
10 Add lines 9a and 9b. This is the total tax due.............................................................................................................. 10
44 999999999 99 44
45 45
11 Enter the interest amount here (see instructions)........................................................................................................ 11
46 999999999 99 46
47 47
12 Enter the penalty amount here (see instructions)........................................................................................................ 12
48 999999999 99 48
49 49
13 Add lines 10, 11 and 12. This is the total amount due................................................................................................. 13
50 999999999 99 50
51 51
52 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 52
53 belief, it is true, accurate and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. 53
54 Authorized officer signature Print name Date Telephone number 54
55 XXXXXXXXXXXXXXXXXXXXX 12/31/2020 (999) 999-9999 55
56 Paid preparer signature Print name Date Telephone number 56
57 57
Paid preparer address XXXXXXXXXXXXXXXXXXXXXCity, town or post office State 12/31/2020ZIP Code(999) PTIN999-9999
58 58
59 XXXXXXXXXXXXXXX XX 99999 P99999999 59
60 60
61 May the Division of Taxation contact your preparer? YES 61
62 Mail to RI Division of Taxation - One Capitol Hill - Providence, RI 02908 62
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