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Wisconsin Deductible Dividends
File with Wisconsin Form 4, 4I, or 5
Read instructions before filling in this schedule
Federal Employer ID Number
2008
Dividend Received
Wisconsin Department of Revenue Name
Name of Payer Corporation 1a b c d e f g h i j k l m n o p q r s t u v w x y z 2 3 4
Date Acquired
Percent Owned
Add lines 1a through 1z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Enter foreign taxes paid on dividends included on line 2 . . . . . . . . . . . . . . . . . . . . . . . .
2 3
Subtract line 3 from line 2 . This is total deductible dividends (enter on Schedule W, line 1) 4
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IC-025i
*C1SY08991*