Form 05-170-A — Texas Franchise Tax Payment Form (Annual)

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Tcode 13050 Taxpayer number Due dateReport year Taxpayer name Annual 1. Total tax due on this report 1. (item 35 from Form 05-158-B or item 17 from Form 05-169) 2. Enter prior payment 2.(e.g. extension payment) 3. Net tax due 3.(item 1 minus item 2) 4. Penalty 4.(see instructions) 5. Interest 5.(see instructions) 6. TOTAL AMOUNT DUE AND PAYABLE 6.(Add items 3, 4 and 5) Make amount payable to TEXAS COMPTROLLER VE/DE PM Date (Rev.9-16/9) Texas Franchise Tax Payment Form Taxpayers who paid $10,000 or more during the preceding fi scal year (Sept. 1 thru Aug. 31) are required to electronically pay their franchise tax. For more information visit www.comptroller.texas.gov/taxes/franchise/filing-requirements.php Mail original to: Texas Comptroller of Public Accounts P.O. Box 149348 Austin, TX 78714-9348 Instructions for each report year are online at www.comptroller.texas.gov/taxes/franchise/forms/. If you have any questions, call 1-800-252-1381.