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Form 500NOLD 2022 Corporation Application
Virginia Department of Taxation
P.O. Box 1500 for Refund Carryback of *VANOLD122888*
Richmond, VA 23218-1500 Net Operating Loss
Enclose Copy of Federal Form 1139
Address Change Name FEIN
Consolidated Return
Number and Street
Combined Return
Coalfield Credit City or Town, State, and ZIP Code
Claimed
1. Year of Loss. Enter the taxable loss year in YYYY format - ex: 2021 or 2022. (Fiscal year – see instructions) ..........
2. (a) Federal NOL for year of loss ...................................................................... .00
(b) Net Virginia fixed date conformity modifications (see instructions) ......................................... .00
(c) Virginia fixed date conformity NOL available for carryback [Line 2(a) plus or minus Line 2(b)] ................... .00
3. Net Virginia modifications for year of loss (exclude fixed date conformity modifications) ........................... .00
2nd Preceding Year 1st Preceding Year
4. Taxable Year to which NOL is carried (Enter in YYYY format - ex: 2019, 2020) ...............
5. (a) Federal taxable income ....................................................... .00 .00
(b) Net Virginia fixed date conformity modifications (see instructions) ...................... .00 .00
(c) Fixed date conformity federal taxable income for Virginia purposes
[Line 5(a) plus or minus Line 5(b)] ............................................... .00 .00
6. Virginia fixed date conformity NOL deducted ......................................... .00 .00
7. Federal taxable income after federal NOL carryback [Line 5(c) minus Line 6] ................ .00 .00
8. Line 6 divided by Line 2(c). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . % %
9. Net Virginia modifications (additions and subtractions) as last determined for year on Line 4
(exclude fixed date conformity modifications) ......................................... .00 .00
10. Line 3 times percentage on Line 8 ................................................. .00 .00
11. Amended Virginia taxable income (Add Lines 7, 9, and 10) .............................. .00 .00
If apportioning income (Sch. 500A filers), complete Lines 12 through 17, otherwise go to Line 18.
12. Total allocable income ........................................................... .00 .00
13. Apportionable income (Subtract Line 12 from Line 11) .................................. .00 .00
14. Apportionment percentage for the year shown on Line 4 (see instructions) .................. % %
15. Income apportioned to Virginia (Multiply Line 13 by Line 14) ............................. .00 .00
16. Income allocated to Virginia ...................................................... .00 .00
17. Add Lines 15 and 16 ............................................................ .00 .00
18. Tax (Multiply Line 11 or Line 17 by 6%) .............................................. .00 .00
19. (a) Nonrefundable tax credits (Enclose Schedule 500CR, corrected 500CR, or explanation) .... .00 .00
(b) Refundable tax credits (Enclose Schedule 500CR, corrected 500CR, or explanation) ...... .00 .00
(c) Total tax credits [Line 19(a) plus Line 19(b)] ....................................... .00 .00
20. Net tax [Line 18 minus Line 19(c)] .................................................. .00 .00
21. Tax paid for taxable year referenced on Line 4 ........................................ .00 .00
22. Refund amount (Line 21 minus Line 20) ............................................. .00 .00
I, the undersigned president, vice-president, treasurer, assistant treasurer, chief accounting officer, or other officer duly authorized to act on behalf of the corporation
for which this return is made, declare under the penalties provided by law that this return (including any accompanying schedules and statements) has been examined
by me and is, to the best of my knowledge and belief, a true, correct, and complete return, made in good faith, for the taxable year stated pursuant to the income
tax laws of the Commonwealth of Virginia. If prepared by a person other than the taxpayer, this declaration is based on all information of which he or she has any
knowledge. By checking the box to the right, I (we) authorize the Department to discuss this return with the undersigned preparer.
Date Signature of Officer Printed Name of Officer Title Phone Number
Date Individual or Firm, Signature of Preparer Print Preparer’s Name and Firm Name Preparer’s Phone Number
Preparer’s FEIN, PTIN, or SSN Approved Vendor Code Address of Preparer
Va. Dept. of Taxation 2601197-W Rev. 07/22
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