Form 207hcc Esa - Estimated Health Care Center Tax Payment Coupon

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207HCC ESA - First Installment
207HCC ESA
Department of Revenue Services
Estimated Health Care Center Tax Payment Coupon
State of Connecticut
For Calendar Year Ending
(Rev. 12/01)
PO Box 2990 Hartford CT 06104-2990
CT Health Care Center Tax Reg. No.
1
Tax shown on 2001 Form 207HCC, Line 17
1
2
Multiply the tax that will be shown on 2002 Form 207HCC by 90% (.90)
2
Date Received (DRS USE ONLY)
3
Required annual payment (Enter the lesser of Line 1 or Line 2)
3
Federal Employer ID Number
4
Multiply Line 3 by 30% (.30)
4
5
Overpayment from prior year applied to this estimate
5
6
Payment due with this coupon (Subtract Line 5 from Line 4)
6
Please change
Due Date:
March 15
name or
Make Checks Payable To:
mailing address,
Commissioner of Revenue Services
or both,
if shown
Mail To:
Department of Revenue Services
incorrectly
Processing Section
at right
PO Box 2990
Hartford CT 06104-2990
207HCC ESB - Second Installment
207HCC ESB
Department of Revenue Services
Estimated Health Care Center Tax Payment Coupon
State of Connecticut
For Calendar Year Ending
(Rev. 12/01)
PO Box 2990 Hartford CT 06104-2990
CT Health Care Center Tax Reg. No.
1
Tax shown on 2001 Form 207HCC, Line 17
1
2
Multiply the tax that will be shown on 2002 Form 207HCC by 90% (.90)
2
Date Received (DRS USE ONLY)
3
Required annual payment (Enter the lesser of Line 1 or Line 2)
3
Federal Employer ID Number
4
Multiply Line 3 by 60% (.60)
4
5
Amount paid with Form 207HCC ESA plus overpayment from prior year
5
6
Payment due with this coupon (Subtract Line 5 from Line 4)
6
Due Date:
June 15
Please change
name or
Make Checks Payable To:
mailing address,
Commissioner of Revenue Services
or both,
if shown
Mail To:
Department of Revenue Services
incorrectly
Processing Section
at right
PO Box 2990
Hartford CT 06104-2990
207HCC ESC - Third Installment
207HCC ESC
Department of Revenue Services
Estimated Health Care Center Tax Payment Coupon
State of Connecticut
For Calendar Year Ending
(Rev. 12/01)
PO Box 2990 Hartford CT 06104-2990
CT Health Care Center Tax Reg. No.
1
Tax shown on 2001 Form 207HCC, Line 17
1
2
Multiply the tax that will be shown on 2002 Form 207HCC by 90% (.90)
2
Date Received (DRS USE ONLY)
3
Required annual payment (Enter the lesser of Line 1 or Line 2)
3
Federal Employer ID Number
4
Multiply Line 3 by 80% (.80)
4
Amount paid with Forms 207HCC ESA and 207HCC ESB plus overpayment from
5
5
prior year
6
Payment due with this coupon (Subtract Line 5 from Line 4)
6
Please change
name or
Due Date:
September 15
mailing address,
or both,
Make Checks Payable To:
if shown
Commissioner of Revenue Services
incorrectly
at right
Mail To:
Department of Revenue Services
Processing Section
PO Box 2990
Hartford CT 06104-2990
207HCC ESD - Fourth Installment
207HCC ESD
Department of Revenue Services
Estimated Health Care Center Tax Payment Coupon
State of Connecticut
For Calendar Year Ending
(Rev. 12/01)
PO Box 2990 Hartford CT 06104-2990
CT Health Care Center Tax Reg. No.
1
Tax shown on 2001 Form 207HCC, Line 17
1
2
Multiply the tax that will be shown on 2002 Form 207HCC by 90% (.90)
2
Date Received (DRS USE ONLY)
3
Required annual payment (Enter the lesser of Line 1 or Line 2)
3
Federal Employer ID Number
4
Amount paid with Forms 207HCC ESA, 207HCC ESB, and 207HCC ESC
4
plus overpayment from prior year
5
Payment due with this coupon (Subtract Line 4 from Line 3)
5
Please change
Due Date:
December 15
name or
Make Checks Payable To:
mailing address,
Commissioner of Revenue Services
or both,
if shown
Mail To:
Department of Revenue Services
incorrectly
Processing Section
at right
PO Box 2990
Hartford CT 06104-2990

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