05-158-A

TEXAS FRANCHISE TAX REPORT - Page 1

(Rev. 1-08/2)
Tcode 13230 Initial
Taxpayer number Report year Due date Privilege period covered by this report

Taxpayer name Secretary of State file number

or Comptroller file number
Mailing address

City State Country ZIP Code Plus 4 Blacken circle if the

address has changed
Blacken circle if Total Revenue is adjusted for
Blacken circle if this is a combined report
Tiered Partnership Election, see 171.1015.
Blacken circle if this is a Corporation or Limited Liability Company Blacken circle if this is an Entity other than a Corporation or Limited Liability Company

m m d d y y m m d d y y SIC code NAICS code

Accounting year Accounting year
begin date end date

REVENUE (Whole dollars only)

1. Gross receipts or sales 1. , , , , .0 0

2. Dividends 2. , , , , .0 0
3. Interest 3. , , , , .0 0
4. Rents 4. , , , , .0 0
5. Royalties 5. , , , , .0 0
6. Gains/losses 6. , , , , .0 0
7. Other income 7. , , , , .0 0
8. Total gross revenue (Add Items 1 thru 7) 8. , , , , .0 0
9. Deductions from gross revenue 9. , , , , .0 0
(Item 8 minus Item 9)
10. TOTAL REVENUE (If less than zero, enter 0) 10. , , , , .0 0
COST OF GOODS SOLD (Whole dollars only)

11. Cost of goods sold 11. , , , , .0 0

12. Indirect or administrative overhead costs 12. , , , , .0 0
(Limited to 4%)
13. Other (See instructions) 13. , , , , .0 0
14. TOTAL COST OF GOODS SOLD (Add items 11 thru 13) 14. , , , , .0 0
COMPENSATION (Whole dollars only)
15. Wages and cash compensation 15. , , , , .0 0
16. Employee benefits 16. , , , , .0 0
17. Other (See instructions) 17. , , , , .0 0
18. TOTAL COMPENSATION (Add items 15 thru 17) 18. , , , , .0 0

Texas Comptroller Official Use Only

VE/DE

PM Date

Page 1 of 2
 


  
   

 

         

         
         
         

         
         
    
 
         
        
         

    
        
 
        
        
        
 
        


 
  



 











