Form Ct-990t - Connecticut Unrelated Business Income Tax Return - 2012
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1
22012
Form CT-990T
Department of Revenue Services
State of Connecticut
Connecticut Unrelated Business Income Tax Return
PO Box 5014
Hartford CT 06102-5014
Complete this return in blue or black ink only.
(Rev. 01/13)
Enter Income Year Beginning
__________________________ , 2012, and Ending
_____________________________
Organization name
(please type or print)
CT Tax Registration Number
Taxpayer
Address
number and street
PO Box
DRS use only
–
– 20
(Please type
or print)
Federal Employer ID Number (FEIN)
City or town
State
ZIP code
Check and Complete All Applicable Boxes
If the organization is annualizing its income check here
Change of:
Mailing address
Closing month (Attach explanation.) Return status:
Amended return
Initial return
Final return
If final return:
Dissolved
Withdrawn
Merged/reorganized: Enter survivor’s CT Tax Reg. Number. ___________________________________
Type of organization:
Corporation
Domestic trust
Foreign trust
Other: Explain _____________________________________
1. Date unrelated trade or business began in Connecticut: _______________________________________________
2. Nature of unrelated trade or business income activity: ______________________________________________________________________________
3. Corporation only: Enter state of incorporation: _________________________________ Date of organization: ________________________________
Date qualified in Connecticut if not incorporated in Connecticut: __________________________________________________________________________
– Attach a Complete Copy of Form 990-T Including all Schedules as Filed With the Internal Revenue Service –
Computation of Income
1. Federal unrelated business taxable income from 2012 federal Form 990-T, Part II, Line 34 .........................
1
00
2. Federal net operating loss deduction from 2012 federal Form 990-T, Part II, Line 31 ...................................
2
00
3. Federal deduction for Connecticut tax on unrelated business taxable income ..............................................
3
00
4. Total: Add Lines 1, 2, and 3. ..........................................................................................................................
4
00
5. Refund or credit for overpayment of Connecticut tax included in federal unrelated business taxable income
5
00
6. Unrelated business taxable income: Subtract Line 5 from Line 4. .................................................................
6
00
Computation of Tax
00
1. Unrelated business taxable income from Line 6 above. If 100% Connecticut, enter also on Line 3. ........
1
2. Apportionment fraction from Schedule A, Line 5 on back page. Carry to six places. .....................................
2
0.
00
3. Connecticut unrelated business taxable income: Line 1 or Line 1 multiplied by Line 2. ................................
3
00
4. Operating loss carryover from Schedule B, Line 13 on back page ................................................................
4
00
5. Income subject to tax: Subtract Line 4 from Line 3. .......................................................................................
5
6. Tax: Multiply Line 5 by 7.5% (.075). ...............................................................................................................
00
6
Computation of Amount Payable
00
1. Tax: Include surtax if applicable. See instructions. .........................................................................................
1
2. Reserved for future use ..................................................................................................................................
2
00
3. Total Tax: Enter the amount from Line 1. ........................................................................................................
3
00
4. Tax credits from Form CT-1120K, Part III, Line 9. Do not exceed amount on Line 1. ................................
4
00
5. Balance of tax payable: Subtract Line 4 from Line 3. If zero or less, enter “0.” ..............................................
5
00
Paid with application for extension from Form CT-990T EXT
6a.
............................................................................
6a
00
Paid with estimates from Forms CT-990T ESA, ESB, ESC, & ESD
6b.
.................................................................
6b
00
Overpayment from prior year
6c.
.................................................................................................................................
6c
00
6. Tax Payments: Enter the total of Lines 6a, 6b, and 6c. .................................................................................
6
00
7. Balance of tax due (overpaid): Subtract Line 6 from Line 5. ..........................................................................
7
.
00
.
.
00
00
00
8. Add Penalty
(8a) ___________ Interest
(8b) ___________ CT-1120I Interest
(8c) ___________
8
.00
.
00
00
9. Amount to be credited to 2013 estimated tax
(9a) _____________ Refunded
(9b) _______________
9
For faster refund, use Direct Deposit by completing Lines 9c, 9d, and 9e.
9c. Checking
Savings
9d. Routing number
9e. Account number
9f. Will this refund go to a bank account outside the U.S.?
Yes
00
10. Balance due with this return: Add Line 7 and Line 8.
10
Visit the DRS website at
Mail to: Dept. of Revenue Services, State of Connecticut,
Make check payable to:
to pay electronically.
PO Box 5014, Hartford CT 06102-5014
Commissioner of Revenue Services
Declaration: I declare under penalty of law that I have examined this return (including any accompanying schedules and statements) and, to the best of my knowledge and belief, it is
true, complete, and correct. I understand the penalty for willfully delivering a false return or document to the Department of Revenue Services (DRS) is a fine of not more than $5,000,
imprisonment for not more than five years, or both. The declaration of a paid preparer other than the taxpayer is based on all information of which the preparer has any knowledge.
May DRS contact the preparer shown
Signature of officer or fiduciary
Date
Sign Here
below about this return? See instructions.
Title
Telephone number
(
)
Yes
No
Keep a copy
Officer’s email address
of this
return for
Paid preparer’s signature
Date
Preparer’s SSN or PTIN
your
records.
Firm’s name and address
FEIN
Telephone number
(
)
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