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4 North Dakota Office of State Tax Commissioner
5 5
6 Form 40X Amended Corporation Income Tax Return 6
7 Calendar Year or Fiscal Year Beginning MM/DD/YYYYand ending MM/DD/YYYY (Rev. 2016) 7
8 Name Federal Employer Identification Number* 8
9 99-9999999 9
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
10 Mailing address Name the original Form 40 was filed under 10
11 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXX 11
12 City, State, Zip Code Phone Number Reason for Changes: 12
13 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 999-999-9999 X RAR X Other 13
14 A B C 14
15 Income and Deductions As originally reported Net change Correct amount 15
16 or as adjusted increased or (decrease) 16
17 1 Income 1 9999999999 (M) 999999999 9999999999 17
18 Fill in the circle for the original tax return filing method 18
19 a. X b. X b1. X b2. X c. X c1. X d. X 19
20 2 Total additions 2 9999999999 (N) 999999999 9999999999 20
21 3 Total subtractions 3 9999999999 (P) 999999999 9999999999 21
22 4 North Dakota apportionable income (Subtract line 3 from the sum of lines 1 and 2) 4 9999999999 9999999999 22
23 5 North Dakota apportionment factor 5 9.999999 (R) 9.999999 23
24 6 Multiply line 4 by line 5 for income apportioned to North Dakota 6 9999999999 9999999999 24
25 7 Income, less related expenses, allocated to North Dakota 7 9999999999 (S) 999999999 9999999999 25
26 8 North Dakota income (Add lines 6 and 7) 8 9999999999 9999999999 26
27 9 Federal tax deduction (tax years prior to January 1, 2004) 9 9999999999 (O) 999999999 9999999999 27
28 10 Exempt income for new and expanding business (attach supporting schedule) 10 9999999999 (A) 999999999 9999999999 28
29 11 Exempt income for renaissance zone activity (attach Schedule RZ) 11 9999999999 (U) 999999999 9999999999 29
30 12 Subtract lines 9, 10 and 11 from line 8 12 9999999999 9999999999 30
31 13 North Dakota net operating loss deduction 13 9999999999 (T) 999999999 9999999999 31
32 14 Subtract line 13 from line 12 14 9999999999 9999999999 32
33 15 Recapture of federal alternative minimum tax (tax years prior to January 1, 2004) 15 9999999999 (E) 999999999 9999999999 33
34 16 Subtotal (subtract line 15 from line 14) 16 9999999999 (F) 9999999999 34
35 35
17 Gross proceeds allocated to North Dakota from sale of
36 North Dakota tax credits (see instructions) 17 9999999999 (V) 999999999 9999999999 36
37 18 North Dakota Taxable Income (see instructions) 18 9999999999 9999999999 37
38 38
Payment or Refund
39 19 Income tax due for amount on line 18, Column C (use tax brackets and rates for year being amended; see below) (C) 19 9999999999 39
40 20 North Dakota alternative minimum tax (tax years 1989 and 1990 only) (B) 20 9999999999 40
41 21 Surtax on water's edge method election (3.5% of amount on line 18 - water's edge filers only 2004 forward) (Z) 21 9999999999 41
42 22 North Dakota income tax due (add lines 19, 20 and 21) 22 9999999999 42
43 23 Tax credits (Y) 23 9999999999 43
44 24 North Dakota net income tax liability (subtract line 23 from line 22) (G) 24 9999999999 44
45 25 North Dakota net income tax liability previously paid after credits (H) 25 9999999999 45
46 26 If line 24 is greater than line 25, enter difference as balance due (enter $0 if less than $5) (J) 26 9999999999 46
47 26a Interest and penalty for balance due line 26 (I) 26a 9999999999 47
48 26b Add lines 26 and 26a for total payment due 26b 9999999999 48
49 27 If line 25 is greater than line 24, enter difference as overpayment (D) 27 9999999999 49
50 27a Interest on overpayment on line 27 (I) 27a 9999999999 50
51 27b Add lines 27 and 27a for amount to be refunded (no refund under $5) 27b 9999999999 51
52 52
53 I declare under the penalties of North Dakota Century Code § 12.1-11-02, which provides for a Class A misdemeanor for making a false statement in a governmental matter, that I have filed an original return and that this 53
amended return, including any accompanying schedules and statements, has been examined by me and to the best of my knowledge and belief is a true, correct, and complete return.
54 Date: Signature of Officer: Title: I authorize the 54
X
55 North Dakota Office of 55
56 Date: Signature of Preparer: Address: State Tax Commissioner 56
to discuss this return
57 with the preparer. 57
58 Mail to: Office of State Tax Commissioner PLEASE DO NOT WRITE IN THIS SPACE 58
59 600 E. Boulevard Ave. Dept 127, Bismarck, North Dakota 58505-0599 59
60 *Privacy Act Notice - see instructions 60
61 See tax return for year being amended for correct tax rates; or 61
62 visit our web site at www.nd.gov/tax. 62
NACTP
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