502EZ

Schedule VK-1 Information

Name

Address

City

State

ZIP Code

FEIN or SSN

Date Acquired Interest in PTE

Owner's Entity Type

Owner's Participation Type

Owner's Participation %

Amount Withheld by PTE for Owner

Owner Entity WH Exempt Code

Unified Nonresident Return

Total Taxable Income Amounts

Total Deductions

Tax-Exempt Interest Income

Total Additions

Total Subtractions

For Period

Filing Basis Calendar Fiscal Short

For Taxable Year Ending

Account Number

38-

FEIN

F-001

Demographics

Legal Business Name

Initial Filer

Amended Return

Final Return

Name Change

Address Change

Fiscal Year Change

Address

City

State

ZIP

Total Number of Owners

Total Number of Non-Resident Individual Owners

502EZ

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Total of taxable income amounts

Total of deductions

Tax-exempt interest income

Total additions

Total subtractions

Total withholding tax due for nonresident owners

Total withholding paid

Overpayment of withholding

Balance of withholding tax due

Extension Penalty

Is Form 502EZ being filed more than 6 months after the due date or more than 30 days after the federal extended due date?

Yes No

Late Payment Penalty on Tax Due

Interest

Total penalty and interest charges due

Late filing penalty

Net Overpayment

Amount of overpayment to be credited to next year

Amount of overpayment to be refunded

Balance of tax due

Interest charges on withholding tax

Late penalty

Total payment due

Pay via Credit (EFT) Payment

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Bank Routing Number

Bank Account Number

Re-Enter Bank Account Number

Payment Date Today

Schedule Payment For:

Bank Routing Number

Bank Account Number

Payment Amount

Payment Date Once confirmed this date cannot be modified

Your Name

Your Title

Other Title

Phone Number

By checking the box to the left, I (we) authorize the Virginia Department of Taxation to discuss this return with the undersigned Tax Preparer.

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I certify that 100 percent of the Pass-Through Entity's (PTE's) business is in Virginia. I certify that 100 percent of the PTE's income is from Virginia sources. I certify that the PTE's commercial domicile is in Virginia. I certify that the PTE does not have more than 10 owners. I certify that the PTE is not required to file a Virginia Corporation Income Tax Return (Form 500). I certify that the PTE is not filing Schedules 502A and 500AP. I certify that the PTE passes no Schedule CR credits to its owners for the year. I certify that the PTE has no fixed date conformity modifications or adjustments to pass to its owners. I certify that the PTE's total taxable income is greater than or equal to $0 and does not exceed $40,000 for the taxable year of the return. I certify that the total additions and the total subtractions to the total taxable income amounts are each $1,000 or less. I certify that the taxpayer is not a noncorporate home service contract provider who must file a Form 500 and Form 500HS. I certify that the PTE is not electing to pay income tax at the entity level (Form 502PTET filers).

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Form 502EZ - Pass-Through Entity Return of Income and Return of Nonresident Withholding Tax

502EZ

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Form 502EZ - Pass-Through Entity Return of Income and Return of Nonresident Withholding Tax

502EZ

Payment

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