New York State Department of Taxation and Finance
Combined Filer Statement for
Newly Formed Groups Only
Employer identiﬁcation number of parent corporation
Tax period/year of combined corporate franchise tax return
Legal name of parent corporation
Number and street or PO box
Are you requesting a refund on your
combined franchise tax return?
This statement is to be ﬁled only by corporations that are forming a new combined group. Complete the back of this
statement to show the current information about the new combined group. Existing combined groups will be sent a
preprinted statement each year to verify the members of the group and to add or remove any corporations from the group.
Please submit this form, prior to the due date of the combined franchise tax return, directly to: NYS Tax Department
Combined Filer Services Group, W A Harriman Campus, Albany NY 12227, to expedite the recording of your group
information. If you have changes to the group information prior to ﬁling, indicate the changes on a copy of the previously
submitted Form CT-51 and attach it to the return. If not previously ﬁled, this form must be submitted with your combined
corporate franchise tax return to the address on the return.
Note: All information in this statement is subject to review and adjustment by the Audit Division in determining
whether the group meets the legal requirements for ﬁling a combined return.
Please enter below the name, address, and telephone number of an authorized individual whom we may contact to clarify
information if needed. By returning this statement with the corporate franchise tax return for the combined group, the
taxpayers in the combined group are authorizing the representative named below to receive and provide tax information
for the combined group, including the parent and all subsidiaries.
Mailing address of representative
Please be sure to enter each group member’s own federal employer identiﬁcation number (EIN) on the back page.