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BIR Form No.

1701Q

Page 1 of 1

(To be filled up by the BIR)


> DLN:

> Taxpayer PSOC:

> PSIC:

> Spouse PSOC:

For Self-Employed Individuals, Estates, and Trusts


(Including those with both Business & Compensation Income)
Fill in all applicable spaces. Mark all appropriate boxes with an X.
1 For the Year
2 Quarter

(YYYY)

1st

2014

2nd

1701Q
July 2008(ENCS)

4 No. of sheet/s

Amended Return?

3rd

Yes

Taxpayer/Filer
236

299

219

Spouse
6 RDO 024

000

7 TIN

8 RDO
Code

000

Code

attached?

No

Background Information

Part I

5 TIN

> PSIC:
BIR Form No.

Quarterly Income
Tax Return

Republika ng Pilipinas
Kagawaran ng Pananalapi
Kawanihan ng Rentas Internas

Taxpayer's Name (Last Name, First Name, Middle Name) (Estates & Trusts)

10

Spouse's Name(Last Name,FirstName,Middle Name) (if applicable)

TRINIDAD, MARILUZ RAYMUNDO

11

12

Registered Address

Registered Address

1281 A, B, C, ROSARIO STREET TAMARAW HILLS VALENZUELA CITY

13 Date of Birth (mm/dd/yyyy )


11

19

05

14

ZIP Code

Line of
Business/Occupation

20 ATC

LEASING

23

16 Date of Birth (mm/dd/yyyy )

Tel. No.

IIO11

Compensation

II012

Business

II013

Mixed Income

21

24
40% Optional Standard Deduction

18

Tel. No.

22 ATC

II011

Compensation

II012

Business

II013

Mixed Income

Yes

No

40% Optional Standard Deduction


If yes, specify

Computation of Tax

Sales/Revenues/Receipts/Fees
Add: Amount Rec'd by a partner from General Professional Partnership
(except loans)
Total
Less: Cost of Sales/Service
Gross Income from Operation
Add: Other Income
Total Gross Income
Less: Deductions
Taxable Income This Quarter
Add: Taxable Income Previous Quarter(s)
Taxable Income To Date
Tax Due

Taxpayer/Filer
26A
27A
28A
29A
30A
31A
32A
33A
34A
35A
36A
37A

Spouse
26B
27B

81,000.00
0.00

0.00
0.00

28B
29B
30B
31B
32B
33B
34B
35B
36B
37B

81,000.00
0.00
81,000.00
0.00
81,000.00
32,400.00
48,600.00
0.00
48,600.00
5,290.00

0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

Less: Tax Credits/Payments


38A/B Prior Years' Excess Credits
38C/D Tax Payment/s for the Previous Quarter(s)
38E/F Creditable Tax Withheld for the Previous Quarter(s)
38G/H Creditable Tax Withheld per BIR Form 2307 for this Quarter
38I/J Tax Paid in Return Previously Filed, if this is an Amended Return
38K/L Other Payment/s Made (please attach proof of payment-BIR Form
No. 0605)
38M/N Total Tax Credits/Payments (Sum of 38A,C,E,G,I & K/38B,D,F,H,J
& L)
Tax Payable/(Overpayment) (37A less 38M & 37B less 38N)
Add: Penalties

Surcharge
Interest
Compromise

Total Penalties (Sum of Items 40A,C,E/40B,D,F)

41

ZIP Code

Method of Deduction

Itemized Deduction

Declaration This Quarter

39
40

Line of
Business/Occupation

Are you availing of tax relief under Special Law or International Tax Treaty?

Part II

26
27
28
29
30
31
32
33
34
35
36
37
38

17

2931112

Method of Deduction

Itemized Deduction

25

15

1441

1966

Total Amount Payable/(Overpayment) (39A+40G/39B+40H)


Aggregate Amount Payable/(Overpayment) (Sum of Items 41A & 41B)

38A
38C
38E
38G
38I
38K
38M
39A
40A
40C
40E
40G
41A

38B
38D
38F
38H
38J
38L

0.00
0.00
0.00
0.00
0.00
0.00

0.00
0.00
0.00
0.00
0.00
0.00

38N
39B
40B
40D
40F
40H
41B

0.00
5,290.00
1,322.50
11.76
1,500.00
2,834.26
8,124.26

41C

0.00
0.00
0.00
0.00
0.00
0.00
0.00
8,124.26

file:///C:/Users/Alex/AppData/Local/Temp/%7BC8E2623C-5A89-4BF1-8682-9D473C4...

11/20/2014

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