CAPE CRUSADERS Sample Return

(1)

Sample Return

ARTHUR DIMARSKY

32 ERIC LN

STATEN ISLAND NY

(646)637-3269

08-02-2011

CAPE CRUSADERS 11-1111111

INSTRUCTIONS FOR FILING 2010 FEDERAL FORM 1120S

.YOUR TAX OBLIGATION IS EXACTLY MET. NO ADDITIONAL TAX IS DUE.

.AN OFFICER MUST SIGN THE RETURN.

.MAIL YOUR RETURN ON OR BEFORE 09-15-2011 TO:

DEPARTMENT OF THE TREASURY

INTERNAL REVENUE SERVICE CENTER

CINCINNATI, OH 45999-0013

__________________________________________________________________________

INSTRUCTIONS FOR FILING 2010 GEORGIA FORM 600S

.YOUR RETURN HAS A BALANCE DUE OF $10.00.

.AN OFFICER MUST SIGN THE RETURN.

.MAKE A CHECK FOR $10.00 PAYABLE TO: TAXPAYER SERVICES DIVISION

.WRITE YOUR EMPLOYER IDENTIFICATION NUMBER ON THE CHECK.

.THE PAYMENT IS DUE IMMEDIATELY AND SHOULD BE MAILED AS SOON AS POSSIBLE.

.FORM 600 S-CA MUST BE SIGNED AND DATED BY EACH NONRESIDENT SHAREHOLDER.

.MAIL YOUR RETURN ON OR BEFORE 09-15-2011 TO:

GA DEPARTMENT OF REVENUE

PROCESSING CENTER

PO BOX 740391

ATLANTA, GA 30374-0391

__________________________________________________________________________

INSTRUCTIONS FOR FILING 2010 KANSAS FORM K-120S

.YOUR TAX OBLIGATION IS EXACTLY MET. NO ADDITIONAL TAX IS DUE.

.AN OFFICER MUST SIGN THE RETURN.

.MAIL YOUR RETURN ON OR BEFORE 10-18-2011 TO:

PARTNERSHIP OR SMALL BUSINESS TAX

KANSAS DEPARTMENT OF REVENUE

915 SW HARRISON STREET

TOPEKA KS 66699-4000

__________________________________________________________________________

INSTRUCTIONS FOR FILING 2010 LOUISIANA FORM CIFT-620

.YOUR RETURN HAS A BALANCE DUE OF $185.00.

.AN OFFICER MUST SIGN THE RETURN.

.MAKE A CHECK FOR $185.00 PAYABLE TO: LOUISIANA DEPT OF REVENUE

.WRITE YOUR EMPLOYER IDENTIFICATION NUMBER ON THE CHECK.

.THE PAYMENT IS DUE IMMEDIATELY AND SHOULD BE MAILED AS SOON AS POSSIBLE.

.MAIL YOUR RETURN ON OR BEFORE 11-15-2011 TO:

LOUISIANA DEPARTMENT OF REVENUE

PO BOX 91011

BATON ROUGE, LA 70821-9011

Sample Return

(2)

.

ARTHUR DIMARSKY

32 ERIC LN

STATEN ISLAND NY

(646)637-3269

08-02-2011

CAPE CRUSADERS 11-1111111

INSTRUCTIONS FOR FILING 2010 NEW MEXICO FORM PTE

.YOUR RETURN HAS A BALANCE DUE OF $1,262.00.

.AN OFFICER MUST SIGN THE RETURN.

.MAKE A CHECK FOR $1,262.00 PAYABLE TO: NM TAXATION & REVENUE DEPT

.WRITE YOUR EMPLOYER IDENTIFICATION NUMBER ON THE CHECK.

.THE PAYMENT IS DUE IMMEDIATELY AND SHOULD BE MAILED AS SOON AS POSSIBLE.

.MAIL RETURN ON OR BEFORE 09-15-2011 TO:

NM TAXATION & REVENUE DEPT

P.O. BOX 25127

SANTA FE, NM 87504-5127

__________________________________________________________________________

INSTRUCTIONS FOR FILING 2010 NEW YORK FORM CT-3-S

.YOUR RETURN HAS A BALANCE DUE OF $300.00.

.AN OFFICER MUST SIGN THE RETURN.

.MAKE A CHECK FOR $300.00 PAYABLE TO: NY STATE CORPORATION TAX

.WRITE YOUR EMPLOYER IDENTIFICATION NUMBER ON THE CHECK.

.THE PAYMENT IS DUE IMMEDIATELY AND SHOULD BE MAILED AS SOON AS POSSIBLE.

.MAIL YOUR RETURN ON OR BEFORE 03-15-2011 TO:

NYS CORPORATION TAX

PROCESSING UNIT

PO BOX 22092

ALBANY, NY 12201-2092

Sample Return

(3)

Department of the Treasury Internal Revenue Service

(see instructions)

Check if Sch. M-3 attached

Gross receipts or sales Less returns and allowances Bal

S F E O E R I L N I S M T I R T U A C T T I I O O N N S S

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

May the IRS discuss this return with the preparer shown below (see inst.)?

TWF 39193 Copyright Forms (Software Only) - 2010 TW JVA

OMB No. 1545-0130 Form

, 20

For calendar year 2010 or tax year beginning , 2010, ending

S election Name Number, street, room/suite no. City/town, state, & Zip code

effective date

Business activity _{Date incorporated}

code number

Total assets (see inst.)

$

Is the corporation electing to be an S corporation beginning with this tax year? Yes No If ``Yes," attach Form 2553 if not already filed

Check if: Final return Name change Address change

Amended return S election termination or revocation

Enter the number of shareholders who were shareholders during any part of the tax year

Include trade or business income and expenses on lines 1a through 21. See the instructions for more information.

Cost of goods sold (Schedule A, line 8) Gross profit. Subtract line 2 from line 1c

Net gain (loss) from Form 4797, Part II, line 17 (attach Form 4797) Other income (loss) (see instructions -- attach statement)

Add lines 3 through 5 Compensation of officers

Salaries and wages (less employment credits) Repairs and maintenance

Bad debts Rents

Taxes and licenses Interest

Depreciation not claimed on Schedule A or elsewhere on return (attach Form 4562) Depletion

Advertising

Pension, profit-sharing, etc., plans Employee benefit programs Other deductions (attach statement)

Add lines 7 through 19

Subtract line 20 from line 6 Excess net passive income or LIFO recapture tax (see instructions) Tax from Schedule D (Form 1120S)

Add lines 22a and 22b (see instructions for additional taxes)

2010 estimated tax payments and 2009 overpayment credited to 2010 Tax deposited with Form 7004

Credit for federal tax paid on fuels (attach Form 4136) Add lines 23a through 23c

Estimated tax penalty (see instructions). Check if Form 2220 is attached

If line 23d is smaller than the total of lines 22c and 24, enter amount owed If line 23d is larger than the total of lines 22c and 24, enter amount overpaid Enter amount from line 26

Signature of officer Date Title

Preparer's signature if PTIN

Print/Type preparer's name Date Check

self-employed

Firm's name Firm's EIN

Firm's address Phone no.

Form (2010)

Do not file this form unless the corporation has filed or is attaching Form 2553 to elect to be an S corporation.

See separate instructions.

Employer ID no. A D TYPE B _E OR PRINT F C G H (1) (2) (3) (4) (5) I Caution. only 1a b c 1c I ₂ ₂ N 3 3 C O ₄ ₄ M 5 5 E

6 Total income (loss). 6

7 7 8 8 9 9 10 10 D ₁₁ ₁₁ E 12 12 D U ₁₃ ₁₃ C 14 14 T

I 15 (Do not deduct oil and gas depletion.) 15

O ₁₆ ₁₆ N 17 17 S 18 18 19 19 20 Total deductions. 20

21 Ordinary business income (loss). 21

22a 22a T b 22b A X _c _22c A 23a 23a N b 23b D c 23c P A d 23d Y 24 24 M E 25 Amount owed. 25 N T 26 Overpayment. 26 S

27 Credited to 2011 estimated tax Refunded 27

Yes No

For Paperwork Reduction Act Notice, see separate instructions. 10 1120S12

Paid

Preparer

Use Only

1120S

U.S. Income Tax Return for an S Corporation

Sign

Here

1120S

2010

j

k

l

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05-01-2001

CAPE CRUSADERS

11-1111111

567 WAYNE LANE

05-01-2002

999999

MANHATTAN NY 10001

898,322

X

3 600,000

600,000

59,000

541,000

250,000

55,000

100 60,000

6,100

371,200

169,800

0

0 VICE PRESIDENT

X

A

P00011111

ARTHUR DIMARSKY

32 ERIC LN

STATEN ISLAND NY 10308

(646)637-3269

#1

#2

Sample Return

(4)

Form 1120S (2010) Page

(see instructions) Inventory at beginning of year

Purchases Cost of labor

Additional section 263A costs (attach statement) Other costs (attach statement)

Add lines 1 through 5 Inventory at end of year

Subtract line 7 from line 6. Enter here and on page 1, line 2

Check all methods used for valuing closing inventory: (i) Cost as described in Regulations section 1.471-3 (ii) Lower of cost or market as described in Regulations section 1.471-4

(iii) Other (Specify method used and attach explanation.)

Check if there was a writedown of subnormal goods as described in Regulations section 1.471-2(c) Check if the LIFO inventory method was adopted this tax year for any goods (if checked, attach Form 970) If the LIFO inventory method was used for this tax year, enter percentage (or amounts) of closing inventory computed under LIFO

If property is produced or acquired for resale, do the rules of section 263A apply to the corporation? Yes No

Was there any change in determining quantities, cost, or valuations between opening and closing inventory? Yes No

If ``Yes," attach explanation.

(see instructions)

Accrual

Check accounting method: Cash Other (specify)

See the instructions and enter the:

Business activity Product or service

At the end of the tax year, did the corporation own, directly or indirectly, 50% or more of the voting stock of a domestic corporation? (For rules of attribution, see section 267(c).) If ``Yes," attach a statement showing: name and employer identification number (EIN), percentage owned, and if 100% owned, was a qualified subchapter S subsidiary

election made?

Has this corporation filed, or is it required to file, Material Advisor Disclosure Statement, to provide information on any reportable transaction?

Check this box if the corporation issued publicly offered debt instruments with original issue discount

If checked, the corp. may have to file Information Return for Publicly Offered Original Issue Discount Instruments. If the corporation: was a C corporation before it elected to be an S corporation the corporation acquired an asset with a basis determined by reference to the basis of the asset (or the basis of any other property) in the hands of a C corporation

has net unrealized built-in gain in excess of the net recognized built-in gain from prior years, enter the net unrealized built-in gain reduced by net recognized built-in gain from prior years (see instructions) $

$ Enter the accumulated earnings and profits of the corporation at the end of the tax year.

Are the corporation's total receipts (see instructions) for the tax year its total assets at the end of the tax year less than $250,000? If ``Yes," the corporation is not required to complete Schedules L and M-1

During the tax year, was a qualified subchapter S subsidiary election terminated or revoked? If ``Yes," see instructions

Ordinary business income (loss) (page 1, line 21) Net rental real estate income (loss) (attach Form 8825) Other gross rental income (loss)

Expenses from other rental activities (attach statement) Other net rental income (loss). Subtract line 3b from line 3a Interest income

Dividends: Ordinary dividends Qualified dividends Royalties

Net short-term capital gain (loss) (attach Schedule D (Form 1120S)) Net long-term capital gain (loss) (attach Schedule D (Form 1120S)) Collectibles (28%) gain (loss)

Unrecaptured section 1250 gain (attach statement) Net section 1231 gain (loss) (attach Form 4797)

Other income (loss) (see instructions) Type

Form (2010) 1 1 2 2 3 3 4 4 5 5 6 Total. 6 7 7

8 Cost of goods sold. 8

9a b c d 9d e f Yes No 1 a b c 2 a b 3 (a) (b) (c) 4 Form 8918, 5 Form 8281, 6 (a) or and (b) 7 8 and 9 Total amount 1 1 2 2 3a 3a I b 3b N c 3c C O 4 4 M ₅ _a _5a E b 5b 6 6 7 7 L O _8a _8a S b 8b S c 8c 9 9 10 10 10 1120S12

2 Schedule A

Cost of Goods Sold

Schedule B

Other Information

Schedule K

Shareholders' Pro Rata Share Items

1120S

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95,000

30,000

125,000

66,000

59,000

X

UNCLASSIFIED

FIGHTING CRIME

X

169,800

3,000

1,000

30,000

15,000

CAPE CRUSADERS 11-1111111

Sample Return

(5)

(continued) Section 179 deduction (attach Form 4562)

Contributions

Investment interest expense

Section 59(e)(2) expenditures Type Amount

Other deductions (see instructions) Type Low-income housing credit (section 42(j)(5)) Low-income housing credit (other)

Qualified rehabilitation expenditures (rental real estate) (attach Form 3468) Other rental real estate credits (see instructions) Type

Other rental credits (see instructions) Type

Alcohol and cellulosic biofuel fuels credit (attach Form 6478) Other credits (see instructions) Type

Name of country or U.S. possession Gross income from all sources

Gross income sourced at shareholder level Foreign gross income sourced at corporate level Passive category

General category Other (attach statement)

Deductions allocated and apportioned at shareholder level Interest expense

Other

Deductions allocated and apportioned at corporate level to foreign source income Passive category

General category Other (attach statement) Other information

Total foreign taxes (check one): Paid Accrued

Reduction in taxes available for credit (attach statement) Other foreign tax information (attach statement) Post-1986 depreciation adjustment

Adjusted gain or loss

Depletion (other than oil and gas)

Oil, gas, and geothermal properties--gross income Oil, gas, and geothermal properties--deductions Other AMT items (attach statement)

Tax-exempt interest income Other tax-exempt income Nondeductible expenses

Distributions (attach statement if required) (see instructions) Repayment of loans from shareholders

Investment income Investment expenses

Dividend distributions paid from accumulated earnings and profits Other items and amounts (attach statement)

Combine the amounts on lines 1 through 10 in the far right column. From the result, subtract the sum of the amounts on lines 11 through 12d and 14l

Form (2010)

Shareholders' Pro Rata Share Items Total amount

11 11 12a 12a Deduc- _b _12b tions c (1) (2) 12c(2) d 12d 13a 13a b 13b c 13c Credits d 13d e 13e f 13f g 13g 14a b 14b c 14c d 14d e 14e f 14f Foreign g 14g Trans-actions h 14h i 14i j 14j k 14k l 14l m 14m n 15a 15a Altern-b 15b ative Mini- _c _15c mum d 15d Tax (AMT) e 15e Items f 15f 16a 16a Items Affect- b 16b ing c 16c Share-holder d 16d Basis _e _16e 17a 17a Other _b _17b Inform-c 17c ation d

Recon- ₁₈ _{Income/loss reconciliation.} ciliation 18 10 1120S34

3 1120S

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125,000

1,500

5,000

40,000

4,000

92,300

CAPE CRUSADERS 11-1111111

#3

#4

Sample Return

(6)

Mortgages, notes, bonds payable in less than 1 yr

Mortgages, notes, bonds payable in 1 year or more

Adjustments to shareholders' equity (attach stmt.)

Income (loss) (Schedule K, line 18). Line 4 less line 7

Balance at end of tax year. Subtract line 7 from line 6

Beginning of tax year End of tax year

Cash

Trade notes and accounts receivable

Less allowance for bad debts ( ) ( )

Inventories

U.S. government obligations

Tax-exempt securities (see instructions) Other current assets (attach statement) Loans to shareholders

Mortgage and real estate loans Other investments (attach statement) Buildings and other depreciable assets

Less accumulated depreciation ( ) ( )

Depletable assets

(

Less accumulated depletion ( ) )

Land (net of any amortization) Intangible assets (amortizable only)

Less accumulated amortization ( ) ( )

Other assets (attach statement) Total assets

Accounts payable

Other current liabilities (attach statement) Loans from shareholders

Other liabilities (attach statement) Capital stock

Additional paid-in capital Retained earnings

)

Less cost of treasury stock ( ) (

Total liabilities and shareholders' equity

Schedule M-3 required instead of Schedule M-1 if total assets are $10 million or more -- see instructions Income recorded on books this year not

Net income (loss) per books

included on Schedule K, lines 1 through

Income included on Schedule K, lines 1, 2, _{10 (itemize):}

3c, 4, 5a, 6, 7, 8a, 9, and 10, not recorded

Tax-exempt interest $ on books this year (itemize):

Expenses recorded on books this year not Deductions included on Schedule K, lines

included on Schedule K, lines 1 through 1 through 12 and 14l, not charged against

12 and 14l (itemize): book income this year (itemize):

Depreciation $ Depreciation $

Travel and entertainment $

Add lines 5 and 6 Add lines 1 through 3

(see instructions)

Shareholders'

Accumulated Other adjustments _{undistributed taxable}

adjustments account account _{income previously taxed}

Balance at beginning of tax year Ordinary income from page 1, line 21 Other additions

Loss from page 1, line 21 ( )

Other reductions ( ) ( )

Combine lines 1 through 5

Distributions other than dividend distributions

Form (2010)

Balance Sheets per Books

Assets (a) (b) (c) (d) 1 2a b 3 4 5 6 7 8 9 10a b 11a b 12 13a b 14 15

Liabilities and Shareholders' Equity 16 17 18 19 20 21 22 23 24 25 26 27 5 1 2 a 3 6 a a b 7 4 8 (c) (a) (b) 1 2 3 4 5 6 7 8 10 1120S34

4 Schedule L

Schedule M-1

Reconciliation of Income (Loss) per Books With Income (Loss) per Return

Note:

Schedule M-2

Analysis of Accumulated Adjustments Account, Other Adjustments Account, and

Shareholders' Undistributed Taxable Income Previously Taxed

1120S

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

199,039

807,022

2,500

3,300

2,500

3,300

95,000

66,000

11,000

12,000

125,000

10,000

317,539

898,322

155,456

8,000

680,939

5,000

157,083

204,383

317,539

898,322

87,300

5,000

92,300

157,083

169,800

49,000

131,500

244,383

40,000

204,383

CAPE CRUSADERS 11-1111111

#7

#5

#6

Sample Return

(7)

JVA TWF 39033 Copyright Forms (Software Only) - 2010 TW

OMB No. 1545-0130

Name

Description of property Date acquired Date sold Cost or other

Sales price

(Example: 100 shares of Z Co.) (mo., day, yr.) (mo., day, yr.) basis (see inst.) (Subtract (e) from (d))

Short-term capital gain from installment sales from Form 6252, line 26 or 37 Short-term capital gain or (loss) from like-kind exchanges from Form 8824 Combine lines 1 through 3 in column (f)

(

Tax on short-term capital gain included on line 21 below )

Combine lines 4 and 5. Enter here and on Form 1120S, Schedule K, line 7 or 10

Description of property Date acquired Date sold Cost or other

Sales price

(Example: 100 shares of Z Co.) (mo., day, yr.) (mo., day, yr.) basis (see inst.) (Subtract (e) from (d))

Long-term capital gain from installment sales from Form 6252, line 26 or 37 Long-term capital gain or (loss) from like-kind exchanges from Form 8824 Capital gain distributions

Combine lines 7 through 10 in column (f)

(

Tax on long-term capital gain included on line 21 below )

Combine lines 11 and 12. Enter here and on Form 1120S, Schedule K, line 8a or 10

(See instructions completing this part.)

Excess of recognized built-in gains over recognized built-in losses (attach computation schedule) Taxable income (attach computation schedule)

Net recognized built-in gain. Enter the smallest of line 14, line 15, or line 6 of Schedule B Section 1374(b)(2) deduction

Subtract line 17 from line 16. If zero or less, enter -0- here and on line 21 Enter 35% of line 18

Section 1374(b)(3) business credit and minimum tax credit carryforwards from C corporation years Subtract line 20 from line 19 (if zero or less, enter -0-). Enter here and on Form 1120S, page 1, line 22b

Attach to Form 1120S. See separate instructions.

Employer identification number

(a) (b) (c) (e) (f) Gain or (loss)

(d) 1 2 2 3 3 4 4 5 5

6 Net short-term capital gain or (loss).

6

(a) (b) (c) (e) (f) Gain or (loss)

(d) 7 8 8 9 9 10 10 11 11 12 12

Net long-term capital gain or (loss). 13 13 before 14 14 15 15 16 16 17 17 18 18 19 19 20 20 21 Tax. 21

For Paperwork Reduction Act Notice, see the Instructions for Form 1120S. Schedule D (Form 1120S) 2010 10 1120SD1

SCHEDULE D

(Form 1120S)

Part I

Short-Term Capital Gains and Losses -- Assets Held One Year or Less

Part II

Long-Term Capital Gains and Losses -- Assets Held More Than One Year

Part III

Built-in Gains Tax

Capital Gains and Losses and Built-in Gains

2010

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CAPE CRUSADERS

11-1111111

FROM SCH K-1 REC'D

J AND M PARTNERSHIPVARIOUS

VARIOUS

30000

100SHRS

INTEL STOCK

04-01-200306-01-2008 30000 5000 25000

FROM SCH K-1 REC'D

J AND M PARTNERSHIPVARIOUS

VARIOUS

-10000

15000

Sample Return

(8)

(business/investment use only -- see instructions)

JVA TWF 38848 Copyright Forms (Software Only) - 2010 TW

Attachment

(99) Sequence No.

Name(s) shown on return Business or activity to which this form relates

If you have any listed property, complete Part V before you complete Part I. Maximum amount (see instructions)

Total cost of section 179 property placed in service (see instructions)

Threshold cost of section 179 property before reduction in limitation (see instructions) Reduction in limitation. Subtract line 3 from line 2. If zero or less, enter

-0-Dollar limitation for tax year. Subtract line 4 from line 1. If zero or less, enter -0-. If married filing separately, see instructions

Description of property Cost (busn. use only) Elected cost

Listed property. Enter the amount from line 29

Total elected cost of section 179 property. Add amounts in column (c), lines 6 and 7 Tentative deduction. Enter the of line 5 or line 8

Carryover of disallowed deduction from line 13 of your 2009 Form 4562

Business income limitation. Enter the smaller of business income (not less than zero) or line 5 (see instructions) Section 179 expense deduction. Add lines 9 and 10, but do not enter more than line 11

Carryover of disallowed deduction to 2011. Add lines 9 and 10, less line 12 Do not use Part II or Part III below for listed property. Instead, use Part V.

include listed property.) (See instructions.) Special depreciation allowance for qualified property (other than listed property) placed in service

during the tax year (see instructions) Property subject to section 168(f)(1) election Other depreciation (including ACRS)

include listed property.) (See instructions.)

MACRS deductions for assets placed in service in tax years beginning before 2010 If you are electing to group any assets placed in service during the tax year into one or more general asset accounts, check here

Month and Basis for depr. _Recovery _Method _Depreciation

Classification of property year placed in _period

Convention deduction service 3-year property 5-year property 7-year property 10-year property 15-year property 20-year property 25 yrs. 25-year property S/L 27.5 yrs. MM S/L Residential rental property 27.5 yrs. MM S/L 39 yrs. MM S/L Nonresidential real property MM S/L Class life S/L 12-year 12 yrs. S/L 40 yrs. 40-year MM S/L (See instructions.) Listed property. Enter amount from line 28

Add amounts from line 12, lines 14 through 17, lines 19 and 20 in column (g), and line 21. Enter here and on the appropriate lines of your return. Partnerships and S corporations -- see instructions

For assets shown above and placed in service during the current year, enter the portion of the basis attributable to section 263A costs

Form (2010)

See separate instructions. Attach to your tax return.

Identifying number Note: 1 1 2 2 3 3 4 4 5 5 (a) (b) (c) 6 7 7 8 8 9 smaller 9 10 10 11 11 12 12 13 13 Note: (Do not 14 14 15 15 16 16 (Do not Section A 17 17 18

Section B -- Assets Placed in Service During 2010 Tax Year Using the General Depreciation System

(b) (c) _(d) _(e) _(f) _(g) (a) 19a b c d e f g h i

Section C -- Assets Placed in Service During 2010 Tax Year Using the Alternative Depreciation System 20a b c 21 21 22 Total. 22 23 23 For Paperwork Reduction Act Notice, see separate instructions.

10 45621

67 Part I

Election To Expense Certain Property Under Section 179

Part II

Special Depreciation Allowance and Other Depreciation

Part III

MACRS Depreciation

Part IV

Summary

4562

(Including Information on Listed Property)

Depreciation and Amortization

4562

2010

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CAPE CRUSADERS

FOR FORM 1120S

11-1111111

SEE SECTION 179 WRKSHT

0 125,000

Sample Return

(9)

Ordinary business inc. (loss) Department of the Treasury

Internal Revenue Service

Net rental real estate inc. (loss)

Other net rental income (loss)

Net short-term cap. gain (loss)

Net long-term cap. gain (loss)

Collectibles (28%) gain (loss)

Unrecaptured sec. 1250 gain

Alternative min. tax (AMT) items

Final K-1 Amended K-1 OMB No. 1545-0130

For calendar year 2010, or tax Credits

year beginning , 2010

ending , 20

Interest income

Ordinary dividends Corporation's employer identification number

Qualified dividends Foreign transactions

Corporation's name, address, city, state, and ZIP code

Royalties

IRS Center where corporation filed return

Shareholder's identifying number

Net section 1231 gain (loss) Shareholder's name, address, city, state, and ZIP code

Other income (loss)

Shareholder's percentage of stock

% ownership for tax year

Section 179 deduction Items affecting

shareholder basis Other deductions

Other information

* See attached statement for additional information.

13 1

2 3 See page 2 and separate instructions.

4 A 5a B 5b 14 6 7 C 8a 8b D 8c E 9 10 15 F 11 16 12 17

For Paperwork Reduction Act Notice, see Instructions for Form 1120S. Schedule K-1 (Form 1120S) 2010 10 120SK112

Schedule K-1

_{Shareholder's Share of Current Year Inc.,}

Part III

(Form 1120S)

Deductions, Credits, and Other Items

Information About the Corporation

Part I

Information About the Shareholder

Part II

For IRS Use Only

Shareholder's Share of Income, Deductions,

Credits, etc.

2010

671110

j

. . . .

56,611

1,000

11-1111111

333 CAPE CRUSADERS

333 567 WAYNE LANE

MANHATTAN NY 10001

10,002

CINCINNATI

5,001

111-11-1111

BATMAN

567 WAYNE LANE

MANHATTAN NY 10001

33.340000

41,675

C* 1,667

A* 500 D

13,336

A

1,334

#1

Sample Return

(10)

ending , 20

Interest income

Royalties

Other income (loss)

Other information

13 1

4 A 5a B 5b 14 6 7 C 8a 8b D 8c E 9 10 15 F 11 16 12 17

Schedule K-1

_{Shareholder's Share of Current Year Inc.,}

Part III

(Form 1120S)

Deductions, Credits, and Other Items

Information About the Corporation

Part I

Information About the Shareholder

Part II

For IRS Use Only

Shareholder's Share of Income, Deductions,

Credits, etc.

2010

671110

j

. . . .

56,594

1,000

11-1111111

333 CAPE CRUSADERS

333 567 WAYNE LANE

MANHATTAN NY 10001

9,999

CINCINNATI

5,000

222-22-2222

ROBIN

44 BAT CAVE ROAD

MANHATTAN NY 10001

33.330000

41,663

C* 1,667

A* 500 D

13,332

A

1,333

#2

Sample Return

(11)

ending , 20

Interest income

Royalties

Other income (loss)

Other information

13 1

4 A 5a B 5b 14 6 7 C 8a 8b D 8c E 9 10 15 F 11 16 12 17

Schedule K-1

_{Shareholder's Share of Current Year Inc.,}

Part III

(Form 1120S)

Deductions, Credits, and Other Items

Information About the Corporation

Part I

Information About the Shareholder

Part II

For IRS Use Only

Shareholder's Share of Income, Deductions,

Credits, etc.

2010

671110

j

. . . .

56,595

1,000

11-1111111

334 CAPE CRUSADERS

334 567 WAYNE LANE

MANHATTAN NY 10001

9,999

CINCINNATI

4,999

333-33-3333

BATWOMAN

55 TOUGHER THAN BATMAN AVENUE

MANHATTAN NY 10001

33.330000

41,662

C* 1,666

A* 500 D

13,332

A

1,333

#3

Sample Return

(12)

M0505A

JVA Copyright Forms (Software Only) - 2010 TW 10_CSM1

Income (loss) (Schedule M-1, line 8) carries from Form 1120S, page 3, line 18

Increases:

Deductions on return not charged against book income (Schedule M-1, line 6) Income recorded on books not included on return (Schedule M-1, line 5)

Decreases:

Expenses recorded on books not included on return (Schedule M-1, line 3) Income subject to tax not recorded on books (Schedule M-1, line 2)

Computed net income (loss) per books (Schedule M-1, line 1)

Computation of Net Income (Loss) Per Books Form 1120, Schedule M-1, Line 1

2010 SCHEDULE M-1 EXPLANATION ATTACHMENT

. . . . . . . . . . . . . . . . . . . . . . . .

CAPE CRUSADERS

11-1111111

92,300

5,000

87,300

Sample Return

(13)

JVA Copyright Forms (Software Only) - 2010 TW C0110D 10_DP179O

Attachment Sequence No.

Name(s) shown on return Business or activity to which this form relates

If you have any listed property, complete Part V before you complete Part I. Maximum amount (see instructions)

Total cost of section 179 property placed in service (see instructions) Threshold cost of section 179 property before reduction in limitation Reduction in limitation. Subtract line 3 from line 2. If zero or less, enter

-0-Dollar limitation for tax year. Subtract line 4 from line 1. If zero or less, enter -0-. If married filing separately, see instructions

Description of property Cost (busn. use only) Elected cost

Listed property. Enter the amount from line 29

Total elected cost of section 179 property. Add amounts in column (c), lines 6 and 7 Tentative deduction. Enter the of line 5 or line 8

Carryover of disallowed deduction from line 13 of your 2009 Form 4562

Business income limitation. Enter the smaller of business income (not less than zero) or line 5 (see instructions) Section 179 expense deduction. Add lines 9 and 10, but do not enter more than line 11

Carryover of disallowed deduction to 2011. Add lines 9 and 10, less line 12

See separate instructions. Attach to your tax return.

Identifying number Note: 1 1 2 2 3 3 4 4 5 5 (a) (b) (c) 6 7 7 8 8 9 smaller 9 10 10 11 11 12 12 13 13

For Paperwork Reduction Act Notice, see page 1 of the separate Instructions.

Schedule or Elected

Multiple Description Cost Comment

Form Cost

67 Part I

Election To Expense Certain Property Under Section 179

Section 179 Summary (from Asset Manager)

(Including Information on Listed Property)

Depreciation and Amortization

4562

2010

j

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CAPE CRUSADERS

FOR SECTION 179 SUMMARY

11-1111111

500,000

125,000

2,000,000

500,000

SEE STATEMENT BELOW

125,000

419,800

125,000

K 1 EQUIPMENT 100 115000 115000

K 1 MACHINE 101 10000 10000

TOTAL TO SEC 179 SUMMARY LINE 6: 125000

Sample Return

(14)

JVA Copyright Forms (Software Only) - 2010 TW C0514D 10_LSSTMT

2010 DETAIL STATEMENTS

CAPE CRUSADERS

11-1111111 PAGE 1

STATEMENT #1 - TAXES AND LICENSES (1120S PG1 - DED LINE 12)

STATE INCOME TAXES... 60,000

TOTAL CARRIED TO 1120S PG1 - DED LINE 12... 60,000

__________________________________________________________________________

STATEMENT #2 - OTHER DEDUCTIONS (1120S PG1 LINE 19)

OTHER DEDUCTIONS:

ACCOUNTING... 1,000

MEALS & ENTERTAINMENT 50%... 5,000

OTHER BUSINESS DEDUCTIONS... 100

TOTAL OTHER DEDUCTIONS... 6,100

TOTAL CARRIED TO 1120S PG1 LINE 19... 6,100

__________________________________________________________________________

STATEMENT #3 - CONTRIBUTIONS (1120S PG 3 LINE 12A)

CODE A - CASH CONTRIBUTIONS (50%) 1,500

TOTAL CARRIED TO 1120S PG 3 LINE 12A... 1,500

__________________________________________________________________________

STATEMENT #4 - NONDEDUCTIBLE EXPENSES (1120S PG 3 LINE 16C)

CODE C - DISALLOWED MEALS/ENTERTAINMENT 5,000

TOTAL CARRIED TO 1120S PG 3 LINE 16C... 5,000

__________________________________________________________________________

STATEMENT #5 - OTHER ADDITIONS (1120S PG 4 M-2 LINE 3(A))

INTEREST INCOME... 3,000

DIVIDEND INCOME... 1,000

NET SHORT TERM CAPITAL GAIN... 30,000

NET LONG TERM CAPITAL GAIN... 15,000

TOTAL CARRIED TO 1120S PG 4 M-2 LINE 3(A)... 49,000

__________________________________________________________________________

STATEMENT #6 - OTHER REDUCTIONS (1120S PG 4 M-2 LINE 5(A))

CHARITABLE CONTRIBUTIONS... 1,500

SECTION 179 DEDUCTION... 125,000

DISALLOWED MEALS & ENTERTAINMENT... 5,000

TOTAL CARRIED TO 1120S PG 4 M-2 LINE 5(A)... 131,500

__________________________________________________________________________

Sample Return

(15)

JVA Copyright Forms (Software Only) - 2010 TW C0514D 10_LSSTMT

2010 DETAIL STATEMENTS

CAPE CRUSADERS

11-1111111 PAGE 2

STATEMENT #7 - TAX EXEMPT SECURITIES (1120S PG4 SCH L LINE 5)

BEGINNING ENDING

NEW YORK MUNICIPAL BONDS... 11,000 12,000

TOTAL CARRIED TO 1120S PG4 SCH L LINE 5... 11,000 12,000

__________________________________________________________________________

Sample Return

(16)

Form 1120S

EQUIPMENT 100 07-06-10 200DBHY 7 115,000 0 115,000 0 0 0 0 MACHINE 101 06-01-10 200DBHY 7 10,000 0 10,000 0 0 0 0

0

2 Assets Totals: 125,000 0 125,000 0 0 0

2 Assets Grand Totals: 125,000 0 125,000 0 0 0

Balance Sheet Reconciliation

Grand Totals: 125,000 0 125,000 0 0 0 0 0 0 0 0 0 0 0 Less Future Purchases:

Less Current Year Disposals: 0 0 0 0 0 0 0 0 0 0 0 125,000 0 125,000 End of Year Totals:

125,000

Buildings and Other Depreciable Assets: Prior Depreciation: 0 0 Current Depreciation:

125,000 179:

0 Special Depreciation Allowance:

125,000 Ending Accumulated Depreciation (Per Balance Sheet):

0 Land:

0

Intangible Assets (Amortizable Only): Prior Amortization: 0 0 Current Amortization:

0 179:

0 Special Depreciation Allowance:

0 Ending Accumulated Amortization (Per Balance Sheet):

0

2010 Federal Depreciation Schedule

Description

Date

Method Year

08-02-2011 11-1111111

Cost

Land/

Other

§179 Basis

Prior

Current

Spec

Allow

Cape Crusaders

1 * Asset disposed this year

~C Carryover basis in like-kind exchange transaction ~B Excess basis in like-kind exchange transaction

(17)

2010 SCHEDULE K-1 SUMMARY ATTACHMENT

CAPE CRUSADERS 2010 SYSTEM 1120S

EIN 11-1111111

SCHEDULE D - SHORT-TERM GAIN (LOSS) AND LOSS CARRYOVER

J AND M PARTNERSHIP... 30,000

TOTAL TO SCHEDULE D, LINE 1... 30,000

SCHEDULE D - LONG-TERM GAIN (LOSS) AND LOSS CARRYOVER

J AND M PARTNERSHIP... -10,000

TOTAL TO SCHEDULE D, LINE 7, COL (F)... -10,000

---Sample Return

Sample Return

(18)

Payroll WH Number Nonres. WH Number

(to be used by Foreign Corporations only)

Corporation Tax Return

Georgia Department of Revenue (Approved booklet version)

Income Tax Return Beginning

UET Annualization Exception attached

Ending Original Return

C Corp Last Year Extension

Net Worth Tax Return Amended Return Initial Net Worth

Final Return Composite

Beginning Address Change Name Change

Return Filed Ending

Name (Corporate title) Please give former name if applicable.

A. Federal Employer I.D. Number E. Date of Incorporation

B. GA. Withholding Tax Acct. Number Business Address (Number and Street) F. Incorporated under laws

of what state

State Zip Code

C. GA. Sales Tax Reg. Number City or Town G. Date admitted into GA

Telephone Number

D. NAICS Code Location of Books for Audit (city) & (state) H. Kind of Business

Total Shareholders Total Nonresident Shareholders

I. J. Federal Ordinary Income

K. Indicate latest taxable year adjusted by IRS And when reported to Georgia

(ROUND TO NEAREST DOLLAR)

1. Georgia Taxable Income (See instructions) 1.

2. Tax -- 6% x Line 1 2.

A. Within Georgia B. Total Everywhere C. GA. ratio (A/B) 1. Total value of property owned (Total assets from Federal balance sheet)

2. Gross receipts from business 3. Totals (Line 1 + 2)

4. Georgia ratio (Divide Line 3A by 3B)

1. Total Capital stock issued 1.

2. Paid in or Capital surplus 2.

3. Total Retained earnings 3.

4. Net Worth (Total of Lines 1, 2, and 3) 4.

Ratio (GA. and Dom. For. Corp. -- 100%) (Foreign Corp. -- Line 4, Sch. 2)

5. 5.

Net Worth Taxable by Georgia (Line 4 x Line 5)

6. 6.

7. Net Worth Tax (from table in instructions) 7.

A. Income Tax B. Net Worth Tax C. Total

1. Total Tax (Schedule 1, Line 2 and Schedule 3, Line 7) 1.

2. Less: Credits and payments of estimated tax 2.

3. Less: Credits from Schedule 10, Line 6* 3.

4. Withholding Credits (G-2A, G-2LP and/or G-2RP) 4.

5. Balance of tax due (Line 1, less Lines 2, 3 and 4) 5.

6. Amount of overpayment (Lines 2, 3 and 4 less Line 1) 6.

7. Interest due (See Instructions) 7.

8. Penalty due (See Instructions) 8.

9. Balance of Tax, Interest and Penalty due with return 9.

10. Amount of Line 6 to be credited to 2011 estimated tax Refunded

Any tax credits from Schedule 10 may be applied against income tax liability only, net worth tax liability.

Georgia Form 600S (Rev. 11/10)

(attach explanation)

COMPUTATION OF GEORGIA TAXABLE INCOME AND TAX SCHEDULE 1

SCHEDULE 2 COMPUTATION OF NET WORTH RATIO

SCHEDULE 3 COMPUTATION OF NET WORTH TAX

SCHEDULE 4 COMPUTATION OF TAX DUE OR OVERPAYMENT

*NOTE: not 10 GA600S1

2010

2011

1101500711

1043-j

j

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

01-01-2010

12-31-2010

01-01-2011

12-31-2011

11-1111111

CAPE CRUSADERS

05-01-2002

567 WAYNE LANE

NY

MANHATTAN

NY

10001

05-01-2002

999999

MANHATTAN NY

UNCLASSIFIED

3

3 169800.00

15000.00

898322.00

40000.00

600000.00

55000.00

1498322.00

0.036708

5000.00

204383.00

209383.00

0.036708

7686.00

10.00

0.00

10.00

Sample Return

(19)

C. DO NOT ROUND COL (A)/ COL (B)

COMPUTE TO SIX DECIMALS

Georgia Public Revenue Code Section 48-2-31 stipulates that taxes shall be paid in lawful money of the United States, free of any expense to the State of Georgia. I/We declare under the penalties of perjury that I/we have examined this return (including accompanying schedules and statements) and to the best of my/our knowledge and belief it is true, correct, and complete. If prepared by a person other than taxpayer, their declaration is based on all information of which they have any knowledge.

Check the box to authorize the Georgia Department of SIGNATURE OF OFFICER DATE SIGNATURE OF INDIVIDUAL OR FIRM PREPARING THE RETURN Revenue to discuss the contents

of this tax return with the named

TITLE IDENTIFICATION OR SOCIAL SECURITY NUMBER preparer.

Georgia Form (Corporation) Name FEIN

1. State and municipal bond interest (other than Georgia or political subdivision thereof) 1.

2. 2. Net income or net profits taxes imposed by taxing jurisdictions other than Georgia

3. Expense attributable to tax exempt income 3.

4. Federal deduction for income attributable to domestic production activities (IRC Section 199) 4. Intangible expenses and related interest costs

5. 5.

6. 6. Captive REIT expenses and costs

7. Other Additions (Attach Schedule) 7.

8. TOTAL -- Enter here and on Line 8, Schedule 8 8.

1. Interest on obligations of United States (must be reduced by direct and indirect interest expense) 1. Exception to intangible expenses and related interest costs (Attach IT-Addback)

2. 2.

3. Exception to captive REIT expenses and costs (Attach IT-REIT) 3.

4. Other Subtractions (Must Attach Schedule) 4.

5. TOTAL -- Enter here and on Line 10, Schedule 8 5.

Gross receipts from business 1.

2. Georgia Ratio (Divide Column A by Column B)

1. Ordinary income (loss) per Federal return 1.

2. Net income (loss) from rental real estate activities 2.

3. a. Gross income from other rental activities 3a.

b. Less: expenses 3b.

c. Net business income from other rental activities (Line 3a less Line 3b) 3c.

4. Portfolio income (loss): a. Interest Income 4a.

b. Dividend Income 4b.

c. Royalty Income 4c.

d. Net short-term capital gain (loss) 4d.

e. Net long-term capital gain (loss) 4e.

f. Other portfolio income (loss) 4f.

5. Net gain (loss) under section 1231 5.

6. Other Income (loss) 6.

7. Total Federal Income (Add Lines 1 through 6) 7.

8. Additions to Federal Income (Schedule 5 above) 8.

9. Total (Add Lines 7 & 8) 9.

10. Subtractions from Federal Income (Schedule 6 above) 10.

11. Total Income for Georgia purposes (Subtract Line 10 from Line 9) 11.

Georgia Department of Revenue

Georgia Department of Revenue, Processing Center, P.O. Box 740391, Atlanta, Georgia 30374-0391

600S/2010

ADDITIONS TO FEDERAL TAXABLE INCOME SCHEDULE 5

SCHEDULE 6 SUBTRACTIONS FROM FEDERAL TAXABLE INCOME

APPORTIONMENT OF INCOME SCHEDULE 7

A. WITHIN GEORGIA B. EVERYWHERE

SCHEDULE 8 COMPUTATION OF TOTAL INCOME FOR GEORGIA PURPOSES

A Copy of the Federal Return and supporting Schedules must be attached, otherwise this return shall be deemed incomplete.No extension of time for filing will be allowed unless a copy of the request for a Federal extension or Form IT-303 is attached to this return.

Make check payable to: Mail to: Declaration: Email Address: 10 GA600S2

1101500721

1043-j

j

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CAPE CRUSADERS

11-1111111

0.00

0.00 1.000000

169800.00

3000.00

1000.00

30000.00

15000.00

218800.00

X

VICE PRESIDENT

P00011111

Sample Return

(20)

Georgia Form (Corporation) Name FEIN Page 3

1. Total Income for Georgia purposes (Line 11, Schedule 8) 1.

2. Income allocated everywhere (Must Attach Schedule) 2.

3. Business Income subject to apportionment (Line 1 less Line 2) 3.

4. Georgia Ratio (Schedule 7, Column C) 4.

5. Net business income apportioned to Georgia (Line 3 x Line 4) 5.

6. Net income allocated to Georgia (Attach Schedule) 6.

7. Total Georgia net income (Add Line 5 and Line 6) 7.

See instructions for a list of available credits and their applicable codes. You must list the appropriate credit type code in the space provided.

If the tax credit is flowing or being assigned If you claim more than four credits, attach a schedule. Enter the total of the additional schedule on Line 5.

into this corporation from another corporation, please enter the name and FEIN of the corporation where the tax credit originated. If the credit originated with the corporation filing this return, enter ``Same" in the spaces for corporation and FEIN.

FEIN

Credit Type Code Corporation Name Amount of Credit

1. 1.

2. 2.

3. 3.

4. 4.

5. Enter the total from attached schedule(s) 5.

6. Enter the total of Lines 1 through 5 here and on Schedule 4, Line 3, Page 1 6.

Georgia Code Section 48-7-42 provides that in lieu of claiming any Georgia income tax credit for which a taxpayer otherwise is eligible for the taxable year, the taxpayer may elect to assign credits in whole or in part to one or more ``affiliated entities".The term ``affiliated entities'' is defined as: 1) A corporation that is a member of the taxpayer's affiliated group within the meaning of Section 1504(a) of the Internal Revenue Code; or 2) An entity affiliated with a corporation, business, partnership, or limited liability company taxpayer, which entity:

(a) Owns or leases the land on which a project is constructed; (b) Provides capital for construction of the project; and

(c) Is the grantor or owner under a management agreement with a managing company for the project.

No carryover attributable to the unused portion of any previously claimed or assigned credit may be assigned or reassigned, except if the assignor and the recipient of an assigned tax credit cease to be affiliated entities, then any carryover attributable to the unused portion of the credit is transferred back to the assignor of the credit. The assignor is permitted to use any such carryover and also shall be permitted to assign the carryover to one or more affiliated entities, as if such carryover were an income tax credit for which the assignor became eligible in the taxable year in which the carryover was transferred back to the assignor. In the case of any credit that must be claimed in installments in more than one taxable year, the election under this subsection may be made on an annual basis with respect to each such installment. For additional information, please refer to Georgia Code Section 48-7-42.

If the corporation filing this return is assigning tax credits to other affiliates, please provide detail below specifying where the tax credits are being assigned.

Credit Type Code Corporation Name FEIN Amount of Credit

1. 1. 2. 2. 3. 3. 4. 4. 600S/2010

COMPUTATION OF GEORGIA NET INCOME SCHEDULE 9

CLAIMED TAX CREDITS SCHEDULE 10

ASSIGNED TAX CREDITS SCHEDULE 11

s 48-7-42 (b). All assignments of credits must be made before the statutory due date (including extensions) per O.C.G.A.s

10 GA600S3

1101500731

1043-. 1043-. 1043-. 1043-. 1043-. 1043-. 1043-. 1043-. 1043-. 1043-. 1043-. 1043-. 1043-. 1043-. 1043-. 1043-. 1043-. 1043-. 1043-. 1043-. 1043-. 1043-. 1043-. 1043-. 1043-. 1043-. 1043-. 1043-. 1043-. 1043-. 1043-. 1043-. 1043-. 1043-. 1043-. 1043-. 1043-. 1043-. 1043-. 1043-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CAPE CRUSADERS

11-1111111

218800.00

Sample Return

(21)

Georgia Profit

Name and Address _{Source Income}

Sharing % A. B. C. D. E. F. G. H. I. J. K. L. M. N. O. P. Q. 6. 5. 1 2 4 3 1 2 4 3 1 2 4 3 1 2 4 3 1 2 4 3 1 2 4 3 1 2 4 3 1 2 4 3 1 2 4 3 1 2 4 3 1 2 4 3 1 2 4 3 1 2 4 3 1 2 4 3 1 2 4 3 1 2 4 3 1 2 4 3 Total

2010 GEORGIA SHAREHOLDER SUMMARY

CAPE CRUSADERS

11-1111111

BATMAN

567 WAYNE LANE

MANHATTAN NY 10001

111-11-1111

33.340 72947.00

ROBIN

44 BAT CAVE ROAD

MANHATTAN NY 10001

222-22-2222

33.330 72926.00

BATWOMAN

55 TOUGHER THAN BATMAN AVENUE

MANHATTAN NY 10001

333-33-3333

33.330 72927.00

218800.00

Sample Return

(22)

CALENDAR YEAR or other taxable year Beginning

Ending

Under Sections 48-7-21 and 48-7-27 of the Georgia Income Tax Act and Regulations thereunder, all nonresident shareholders must execute an agreement wherein said shareholders agree to pay Georgia income tax on their proportionate part of the corporation's Georgia taxable income or the S Corporation election will be terminated by the Commissioner.

For Tax year's beginning on or after January 1, 2008, nonresident shareholders of `S' corporations will only need to file a single consent agreement in the year in which the Subchapter `S' corporation is first required to file a Georgia income tax return. For a Subchapter `S' corporation in existence prior to January 1, 2008, the consent agreement must be filed for each shareholder in the first Georgia tax return filed for a year beginning on or after January 1, 2008. A consent agreement will also need to be filed in any subsequent year for any additional nonresident who first becomes a

shareholder of the Subchapter `S' corporation in that year.

As a nonresident shareholder in the above-captioned corporation, I hereby agree to:

File a Georgia Individual Tax Return, Form 500, and report my pro rata share of income and pay any tax due on the return for each tax year; or

Be included in a composite tax return, Form IT CR, filed by the above corporation for each tax year.

Taxpayer's Signature Date

CONSENT AGREEMENT OF NONRESIDENT SHAREHOLDERS OF S CORPORATIONS

To ensure Georgia's recognition of your S Corporation election, attach a properly completed Form 600S-CA for each nonresident shareholder to Form 600S when filed as specified below, even when a composite return has been filed.

FEIN CORPORATE NAME

BUSINESS ADDRESS

STATE Country ZIP CODE

CITY

NONRESIDENT SHAREHOLDER

SOCIAL SECURITY NUMBER NAME

ADDRESS

STATE Country

CITY ZIP CODE

NUMBER OF SHARES OWNED

E-MAIL ADDRESS TELEPHONE NUMBER

10 GA00SC1

FORM 600S-CA

DEPARTMENT OF REVENUE

TAXPAYER SERVICES DIVISION

IF ANY ONE OR MORE NONRESIDENT SHARHOLDERS FAILS OR REFUSES TO FILE THE CONSENT

AGREEMENT HEREIN, DO NOT USE FORM 600S. FILE ON FORM 600.

Create as many copies as needed.

STATE OF GEORGIA

2010

CAPE CRUSADERS

11-1111111

567 WAYNE LANE

MANHATTAN

NY

10001

BATMAN

111-11-1111

567 WAYNE LANE

MANHATTAN

NY

10001

Sample Return

(23)

CALENDAR YEAR or other taxable year Beginning

Ending

Under Sections 48-7-21 and 48-7-27 of the Georgia Income Tax Act and Regulations thereunder, all nonresident shareholders must execute an agreement wherein said shareholders agree to pay Georgia income tax on their proportionate part of the corporation's Georgia taxable income or the S Corporation election will be terminated by the Commissioner.

For Tax year's beginning on or after January 1, 2008, nonresident shareholders of `S' corporations will only need to file a single consent agreement in the year in which the Subchapter `S' corporation is first required to file a Georgia income tax return. For a Subchapter `S' corporation in existence prior to January 1, 2008, the consent agreement must be filed for each shareholder in the first Georgia tax return filed for a year beginning on or after January 1, 2008. A consent agreement will also need to be filed in any subsequent year for any additional nonresident who first becomes a

shareholder of the Subchapter `S' corporation in that year.

As a nonresident shareholder in the above-captioned corporation, I hereby agree to:

File a Georgia Individual Tax Return, Form 500, and report my pro rata share of income and pay any tax due on the return for each tax year; or

Be included in a composite tax return, Form IT CR, filed by the above corporation for each tax year.

Taxpayer's Signature Date

CONSENT AGREEMENT OF NONRESIDENT SHAREHOLDERS OF S CORPORATIONS

To ensure Georgia's recognition of your S Corporation election, attach a properly completed Form 600S-CA for each nonresident shareholder to Form 600S when filed as specified below, even when a composite return has been filed.

FEIN CORPORATE NAME

BUSINESS ADDRESS

STATE Country ZIP CODE

CITY

NONRESIDENT SHAREHOLDER

SOCIAL SECURITY NUMBER NAME

ADDRESS

STATE Country

CITY ZIP CODE

NUMBER OF SHARES OWNED

E-MAIL ADDRESS TELEPHONE NUMBER

10 GA00SC1