Delaware Composite Income Tax Return

Composite Income Tax Return
Form 200C
FORM 200-C

2019

Page 1

DELAWARE COMPOSITE
PERSONAL INCOME TAX RETURN

Print Form

Reset

DO NOT WRITE OR STAPLE IN THIS AREA

FISCAL YEAR
CHECK APPLICABLE BOX:

TO
INITIAL RETURN

FINAL RETURN

AMENDED RETURN

LIST NUMBER OF NON-RESIDENT PARTNERS/SHAREHOLDERS:
NAME OF BUSINESS

EMPLOYER IDENTIFICATION OR SOCIAL SECURITY NUMBER

ADDRESS

CITY

STATE

ZIP CODE

STATE

ZIP CODE

DELAWARE ADDRESS (IF DIFFERENT)

CITY

DATE OF INCORPORATION

STATE OF INCORPORATION

NATURE OF BUSINESS

1. DELAWARE SOURCED INCOME (NON-RESIDENTS ONLY)........................................................................................

1.

2. TAX LIABILITY (MULTIPLY LINE 1 BY .0660 ).................................................................................................................

2.

3. NON REFUNDABLE CREDITS (MUST ATTACH FORM 700)..........................................................................................

3.

4. BALANCE (SUBTRACT LINE 3 FROM LINE 2. CANNOT BE LESS THAN ZERO)........................................................

4.

5. ESTIMATED TAXES PAID (INCLUDE REAL ESTATE ESTIMATED TAXES PAID ON THIS LINE).................................

5.

6. IF LINE 5 IS LESS THAN LINE 4, SUBTRACT LINE 5 FROM LINE 4 AND ENTER HERE.................... PAY IN FULL>

6.

7. IF LINE 4 IS LESS THAN LINE 5, SUBTRACT LINE 4 FROM LINE 5 AND ENTER HERE.......................... REFUND>

7.

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. IF PREPARED BY A PERSON
OTHER THAN THE TAXPAYER, HIS DECLARATION IS BASED ON ALL INFORMATION OF WHICH HE HAS ANY KNOWLEDGE.

SIGNATURE OF AUTHORIZED OFFICER

SIGNATURE OF PREPARER

STREET ADDRESS OF PREPARER

TITLE

PREPARER’S EIN OR SSN

DATE

PREPARER’S PHONE

CITY

DATE

STATE

ZIP

MAKE CHECK PAYABLE AND MAIL TO: DELAWARE DIVISION OF REVENUE, P.O. BOX 508, WILMINGTON, DE 19899-0508

(Rev 04/2019)

*DF21319019999*
DF21319019999