Form 20s Form 65 Schedule Pab "Add-Back Form" - Alabama

Form 65 is a Alabama Department of Revenue form also known as the "Form 20s Schedule Pab - Add-back Form". The latest edition of the form was released in February 1, 2016 and is available for digital filing.

Download an up-to-date Form 65 in PDF-format down below or look it up on the Alabama Department of Revenue Forms website.

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20
PAB
Schedule
Reset Entire Form
_____
170006PB
Alabama Department of Revenue
ADOR
2/2016
(Form 65, 20S)
Add-Back Form
TAXPAYER
TAXPAYER
FOR THE
, 20
through
, 20
NAME:
FEIN:
TAX PERIOD
Related member is defined to include a corporation, association, disregarded entity, or subchapter K entity (Alabama Code section 40-18-1(28) and (29)). Disregarded entities and subchapter K
entities are related members separate and apart from their owner. A column must be completed for each recipient related member.
Related Member 1
Related Member 2
Related Member 3
Related Member 4
Recipient related member who received interest/intangible income from the taxpayer:
1a
1 a. Recipient related member FEIN. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
b. Recipient related member name. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
2 List the intangible expense amounts paid to the recipient related member.. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
3 List the interest expense amounts paid to the recipient related member.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
4 Total intangible/interest expenses paid (total lines 2 and 3). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
To determine the exempt amount of intangible/interest expense, complete the applicable section(s) below.
5 Exemption related to §40-18-35(b)(1) and §40-18-24(b):
5a
a. Jurisdiction(s) where recipient related member income is “subject to tax”: . . . . . . . . . . . . . . . . . . . . . . . . . .
5b
b. Amount of Line 4 expense not added back. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c. Recipient related member’s corresponding intangible/interest income allocated to
5c
jurisdiction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5d
d. Adjusted intangible/interest amount (Line 5b minus Line 5c). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5e
e. Recipient related member’s total apportionment percentage in the above jurisdiction(s). . . . . . . . . . . . . . .
%
%
%
%
5f
f. Adjusted interest/intangible amount (multiply Line 5d by Line 5e). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5g
g. Add Line 5c and Line 5f. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6 Exemption related to §40-18-35(b)(2), §40-18-35(b)(4), §40-18-24(d) and §40-18-24(f)
6
– Amount of Line 4 expense not added back. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
NOTE: For Section 7, 8, 9, and 10 the receipts of a disregarded entity/subchapter K entity, which may be a related entity in and unto itself, may not be combined with receipts of its owner for purposes of this schedule.
7
7 Exemption related to §40-18-35(b)(3) and §40-18-24(e) – Amount of Line 4 expense not added back.. . . .
8a
8 Recipient related member receipts by category:
a. Intangible receipts . . . . . . . . . . . . . . . . . . . . . . . .
8b
b. lnterest receipts . . . . . . . . . . . . . . . . . . . . . . . . . .
9a
9 a.
9b
b.
9c
c.
9d
d.
9e
e.
10a
10 a. If either Lines 8a or 8b are greater than Lines 9a, 9b, 9c, 9d or 9e, enter zero. . . . . . . . . . . . . . . . . . . . . . .
10b
b. If Lines 9a, 9b, 9c, 9d or 9e are greater than Lines 8a or 8b, enter amount from Line 7. . . . . . . . . . . . . . .
11
11 Exempt Amount. Enter the greater of Lines 5g, 6, 10a or 10b. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12 Total Intangible/Interest expenses paid to all related members. (Sum Line 4 for
12
Attach additional pages as needed and enter the totals of Lines 4 and Lines 11 for all
related members from all pages on Page 1, Line 12 and 13.
all related members from all pages.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13 Total Exempt Amount. (Sum Line 11 for all related members from all pages. Subtract Line 13 from
13
Line 12 and enter the difference on Form 65, Schedule A, Line 1 or Form 20S, Schedule A, Line 2). . . . . . . .
In order to qualify for the exemption presented in §40-18-35(b)(3) and §40-18-24(e), Line 10b must be greater
than zero and an informed corporate officer must sign the statement below, executed under penalty of perjury.
With respect to the transaction(s) giving rise to the related member’s interest/intangible expenses and costs, in-
Signature
cluding both the direct interest/intangible expense transaction(s) between the taxpayer and the related member
and any prior organizational restructuring transaction(s) that facilitated such direct interest/ intangible expense
Title
Date
THIS FORM MUST BE ATTACHED TO FORM 65 or 20S.
transactions, tax avoidance (which included the avoidance of a meaningful amount of Alabama tax) was not a prin-
cipal motivating factor.
20
PAB
Schedule
Reset Entire Form
_____
170006PB
Alabama Department of Revenue
ADOR
2/2016
(Form 65, 20S)
Add-Back Form
TAXPAYER
TAXPAYER
FOR THE
, 20
through
, 20
NAME:
FEIN:
TAX PERIOD
Related member is defined to include a corporation, association, disregarded entity, or subchapter K entity (Alabama Code section 40-18-1(28) and (29)). Disregarded entities and subchapter K
entities are related members separate and apart from their owner. A column must be completed for each recipient related member.
Related Member 1
Related Member 2
Related Member 3
Related Member 4
Recipient related member who received interest/intangible income from the taxpayer:
1a
1 a. Recipient related member FEIN. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
b. Recipient related member name. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
2 List the intangible expense amounts paid to the recipient related member.. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
3 List the interest expense amounts paid to the recipient related member.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
4 Total intangible/interest expenses paid (total lines 2 and 3). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
To determine the exempt amount of intangible/interest expense, complete the applicable section(s) below.
5 Exemption related to §40-18-35(b)(1) and §40-18-24(b):
5a
a. Jurisdiction(s) where recipient related member income is “subject to tax”: . . . . . . . . . . . . . . . . . . . . . . . . . .
5b
b. Amount of Line 4 expense not added back. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c. Recipient related member’s corresponding intangible/interest income allocated to
5c
jurisdiction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5d
d. Adjusted intangible/interest amount (Line 5b minus Line 5c). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5e
e. Recipient related member’s total apportionment percentage in the above jurisdiction(s). . . . . . . . . . . . . . .
%
%
%
%
5f
f. Adjusted interest/intangible amount (multiply Line 5d by Line 5e). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5g
g. Add Line 5c and Line 5f. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6 Exemption related to §40-18-35(b)(2), §40-18-35(b)(4), §40-18-24(d) and §40-18-24(f)
6
– Amount of Line 4 expense not added back. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
NOTE: For Section 7, 8, 9, and 10 the receipts of a disregarded entity/subchapter K entity, which may be a related entity in and unto itself, may not be combined with receipts of its owner for purposes of this schedule.
7
7 Exemption related to §40-18-35(b)(3) and §40-18-24(e) – Amount of Line 4 expense not added back.. . . .
8a
8 Recipient related member receipts by category:
a. Intangible receipts . . . . . . . . . . . . . . . . . . . . . . . .
8b
b. lnterest receipts . . . . . . . . . . . . . . . . . . . . . . . . . .
9a
9 a.
9b
b.
9c
c.
9d
d.
9e
e.
10a
10 a. If either Lines 8a or 8b are greater than Lines 9a, 9b, 9c, 9d or 9e, enter zero. . . . . . . . . . . . . . . . . . . . . . .
10b
b. If Lines 9a, 9b, 9c, 9d or 9e are greater than Lines 8a or 8b, enter amount from Line 7. . . . . . . . . . . . . . .
11
11 Exempt Amount. Enter the greater of Lines 5g, 6, 10a or 10b. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12 Total Intangible/Interest expenses paid to all related members. (Sum Line 4 for
12
Attach additional pages as needed and enter the totals of Lines 4 and Lines 11 for all
related members from all pages on Page 1, Line 12 and 13.
all related members from all pages.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13 Total Exempt Amount. (Sum Line 11 for all related members from all pages. Subtract Line 13 from
13
Line 12 and enter the difference on Form 65, Schedule A, Line 1 or Form 20S, Schedule A, Line 2). . . . . . . .
In order to qualify for the exemption presented in §40-18-35(b)(3) and §40-18-24(e), Line 10b must be greater
than zero and an informed corporate officer must sign the statement below, executed under penalty of perjury.
With respect to the transaction(s) giving rise to the related member’s interest/intangible expenses and costs, in-
Signature
cluding both the direct interest/intangible expense transaction(s) between the taxpayer and the related member
and any prior organizational restructuring transaction(s) that facilitated such direct interest/ intangible expense
Title
Date
THIS FORM MUST BE ATTACHED TO FORM 65 or 20S.
transactions, tax avoidance (which included the avoidance of a meaningful amount of Alabama tax) was not a prin-
cipal motivating factor.
20
PAB
Schedule
_____
170007PB
Reset Schedule Only
Alabama Department of Revenue
ADOR
(Form 65, 20S)
Add-Back Form
TAXPAYER
TAXPAYER
FOR THE
, 20
through
, 20
NAME:
FEIN:
TAX PERIOD
A column must be completed for each recipient related member. Attach additional pages as needed and enter the totals of Lines 4 and Lines 11 for all related members from all pages on Page 1, Line 12 and 13.
Related Member 1
Related Member 2
Related Member 3
Related Member 4
Recipient related member who received interest/intangible income from the taxpayer:
1a
1 a. Recipient related member FEIN. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
b. Recipient related member name. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
2 List the intangible expense amounts paid to the recipient related member.. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
3 List the interest expense amounts paid to the recipient related member.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
4 Total intangible/interest expenses paid (total lines 2 and 3). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
To determine the exempt amount of intangible/interest expense, complete the applicable section(s) below.
5 Exemption related to §40-18-35(b)(1) and §40-18-24(b):
5a
a. Jurisdiction(s) where recipient related member income is “subject to tax”: . . . . . . . . . . . . . . . . . . . . . . . . . .
5b
b. Amount of Line 4 expense not added back. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c. Recipient related member’s corresponding intangible/interest income allocated to
5c
jurisdiction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5d
d. Adjusted intangible/interest amount (Line 5b minus Line 5c). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5e
e. Recipient related member’s total apportionment percentage in the above jurisdiction(s). . . . . . . . . . . . . . .
%
%
%
%
5f
f. Adjusted interest/intangible amount (multiply Line 5d by Line 5e). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5g
g. Add Line 5c and Line 5f. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6 Exemption related to §40-18-35(b)(2), §40-18-35(b)(4), §40-18-24(d) and §40-18-24(f)
6
– Amount of Line 4 expense not added back. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
NOTE: For Section 7, 8, 9, and 10 the receipts of a disregarded entity/subchapter K entity, which may be a related entity in and unto itself, may not be combined with receipts of its owner for purposes of this schedule.
7
7 Exemption related to §40-18-35(b)(3) and §40-18-24(e) – Amount of Line 4 expense not added back.. . . .
8a
8 Recipient related member receipts by category:
a. Intangible receipts . . . . . . . . . . . . . . . . . . . . . . . .
8b
b. lnterest receipts . . . . . . . . . . . . . . . . . . . . . . . . . .
9a
9 a.
9b
b.
9c
c.
9d
d.
9e
e.
10a
10 a. If either Lines 8a or 8b are greater than Lines 9a, 9b, 9c, 9d or 9e, enter zero. . . . . . . . . . . . . . . . . . . . . . .
10b
b. If Lines 9a, 9b, 9c, 9d or 9e are greater than Lines 8a or 8b, enter amount from Line 7. . . . . . . . . . . . . . .
11
11 Exempt Amount. Enter the greater of Lines 5g, 6, 10a or 10b. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
FOR RECIPIENT RELATED MEMBERS WHO RECEIVED INTEREST/INTANGIBLE INCOME FROM THE TAXPAYER, PLEASE ATTACH ADDITIONAL SCHEDULES PAB. (ONLY USE THIS PAGE FOR ADDITIONAL MEMBERS)
Page
of
THIS FORM MUST BE ATTACHED TO FORM 65 or 20S.
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