Form It-113-X - Claim For Credit Or Refund Of Personal Income Tax
ADVERTISEMENT
1IT-113-X
New York State Department of Taxation and Finance
Claim for Credit or Refund of
(7/99)
Personal Income Tax
For office use only
Name
Claim for calendar year or fiscal year ending
(first, middle initial, last (for a joint claim, enter spouse’s also) or name of estate or trust)
Name and title of fiduciary
Your social security number
Street address or address of fiduciary
Spouse’s social security number
City, village or post office
State
ZIP code
Fiduciary’s employer identification number
Address on return if different from above
For office use only
Ref. Corres.
Est. Tax
Date Closed
Ref. Lia Hit
AG 1
Name and address of legal representative
Signature
With. Tax
File a separate claim for each tax year
.
(see instructions on back)
1 Type of Claim:
Net operating loss (NOL) carryback
Protective claim
Protest of paid bill/
denied refund
(see instructions on back)
2 Total tax paid: ______________________
Amount of credit or refund claim: ________________________
3 If a net operating loss carryback:
A Enter the year of loss: ______________________________________________
B Enter all tax years affected by the net operating loss carryback: ______________________________________________
The maximum net operating loss deduction that can be claimed in any carryback year is limited to the
positive federal taxable income for that carryback year.
Attach a copy of your original New York State income tax return for the claim year and attach a copy of your
federal income tax return for the loss year.
4 A Does this claim reflect a reduction of federal taxable income? ............................................................
Yes
No
B Was a federal amended return or claim for refund filed? .....................................................................
Yes
No
If you checked Yes , attach a copy and enter the date filed: _________________ , _________
5 Were claims filed for any other years? ....................................................................................................
Yes
No
If you checked Yes , enter the years and the dates the claims were filed: _________________________________________
6 Reasons for claim
(Give a full explanation, including all facts and figures on which this claim is based. Please print or type.):
Certification: I certify that this claim and any attachments are to the best of my knowledge and belief true, correct and complete.
Preparer’s signature
Date
Mark “X” if self-
Your signature
Paid
employed
Preparer’s
Sign
Spouse’s signature (if joint claim)
Firm’s name (or yours, if self-employed)
Preparer’s SSN or PTIN
Use Only
Here
Date
Daytime phone number (optional)
Address
Employer identification number
(
)
IT-113-X (7/99)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial