Form 05-175-A — Texas Franchise Tax Tiered Partnership Report (Annual)

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VE/DE FM Taxpayer number Report year Taxpayer name 0 0 City State ZIP Code address Plus 4 name of partner 5. State of formation 6. 3. Amount of revenue being passed Blacken circle if 7. Blacken circle if lower tier partner upper tier partner Country 1. Lower tier total revenue before election 0 0 2. Par 4. Legal Mailing tner taxpayer number (if none, use FEI number) Tcode 13256 Annual 0 0 City State ZIP Code Mailing address Plus 4 4. Legal name of partner 5. State of formation 6. 3. Amount of revenue being passed Blacken circle if 7. Blacken circle if lower tier partner upper tier partner Country 1. Lower tier total revenue before election 0 0 2. Partner taxpayer number (if none, use FEI number) 0 0 City State ZIP Code Mailing address Plus 4 4. Legal name of partner 5. State of formation 6. 3. Amount of revenue being passed Blacken circle if 7. Blacken circle if lower tier partner upper tier partner Country 1. Lower tier total revenue before election 0 0 2. Partner taxpayer number (if none, use FEI number) (Rev.9-11/3) Texas Franchise Tax Tiered Partnership Report If the lower tier entity's total annualized revenue is greater than the no tax due threshold before passing any revenue to upper tier entities, the lower and upper tier entities are not eligible to file a No Tax Due Information Report form 05-163. Use additional forms (05-175) to report information as necessary. Texas Comptroller O fficial Use Only