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F-1120NameAddressCity/State/ZIP US Dollars CentsFederal Employer Identification Number (FEIN)For calendar year 2015 or tax year beginning _________________, 2015 ending _________________________Year end date ___________________ 1. Federal taxable income (see instructions). Attach pages 1 5 of federal return ........................................ ...... 2. State income taxes deducted in computing federal taxable income (attach schedule) ........................................ ...................................... 3. Additions to federal taxable income (from Schedule I) .................... 4. Total of Lines 1, 2, and 3.

F-1120 Name Address City/State/ZIP US Dollars Cents Federal Employer Identification Number (FEIN) For calendar year 2015 or tax year beginning _____, 2015

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