Form 05-167-A — Texas Franchise Tax Ownership Information Report (Annual)

Taxpayer number Report year Due date
Tcode
CountryMailing address
Taxpayer name
City
Blacken circle if the mailing address has changed.
State ZIP code plus 4
Name
City State ZIP code plus 4
Mailing address

# GENERAL PARTNER

FEI number Percentage of ownership
What type of owner? LIMITED PARTNER OTHER
(Blacken only one)
Name
City State ZIP code plus 4
Mailing address

# GENERAL PARTNER

FEI number Percentage of ownership
What type of owner? LIMITED PARTNER OTHER
(Blacken only one)
Name
City State ZIP code plus 4
Mailing address

# GENERAL PARTNER

FEI number Percentage of ownership
What type of owner? LIMITED PARTNER OTHER
(Blacken only one)
Name of owned (subsidiary) corporation or entity State of formation FEI number Percentage of ownership
Name of owned (subsidiary) corporation or entity State of formation FEI number Percentage of ownership
City State ZIP code plus 4
(see instructions if you need to make changes)
Agent:
Date Area code and phone number
( ) -
Title
VE/DE
PM Date
Texas Franchise Tax Ownership Information Report
Professional Associations or Financial Institutions
You have certain rights under Chapter 552 and 559, Government Code, to review, request and correct information we have on file about you.
SECTION A. Enter the information required for each general partner of a partnership or each trustee of a trust. Also, provide the information for each person or entity that owns an interest of 10 percent or more in this entity.
SECTION B. Enter the information required for each entity, if any, in which this partnership, association, trust or other entity owns an interest of 10 percent or more.
The above information is authorized by Section 171.201(a)(2), Section 171.201(a)(3), 171.202(a)(4) and 171.354 for each entity.
Use additional forms (05-167) for Sections A and B as necessary.
I declare that the information in this document and any attachments is true and correct to the best of my knowledge and belief, as of the date below.
Visit us at www.comptroller.texas.gov/taxes/franchise.
Use www.comptroller.texas.gov/about/contact for locations and phone numbers.
Mail to:
Texas Comptroller of Public Accounts
P.O. Box 149348
Austin, TX 78714-9348