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

207HCC ESA - First Installment

207HCC ESA

STATE OF CONNECTICUT

Estimated Health Care Center Tax

DEPARTMENT OF REVENUE SERVICES

FOR CALENDAR YEAR ENDING

Payment Coupon

PO Box 2990 Hartford CT 06104-2990

(Rev. 12/00)

CT Health Care Center Tax Reg. No.

Tax shown on 2000 Form 207 HCC, Line 15

Multiply the tax that will be shown on 2001 Form HCC by 90% (.90)

Date Received (DRS USE ONLY)

Required annual payment (Enter the lesser of Line 1 or Line 2)

Federal Employer ID Number

Multiply Line 3 by 30% (.30)

Overpayment from prior year applied to this estimate

Payment due with this coupon (Subtract Line 5 from Line 4)

Please change

DUE DATE:

March 15

name or

MAKE CHECKS PAYABLE TO:

mailing address,

or both,

COMMISSIONER OF REVENUE SERVICES

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

STATE OF CONNECTICUT

Estimated Health Care Center Tax

DEPARTMENT OF REVENUE SERVICES

FOR CALENDAR YEAR ENDING

Payment Coupon

PO Box 2990 Hartford CT 06104-2990

(Rev. 12/00)

CT Health Care Center Tax Reg. No.

Tax shown on 2000 Form 207 HCC, Line 15

Multiply the tax that will be shown on 2001 Form HCC by 90% (.90)

Date Received (DRS USE ONLY)

Required annual payment (Enter the lesser of Line 1 or Line 2)

Federal Employer ID Number

Multiply Line 3 by 60% (.60)

Amount paid with Form 207HCC ESA plus overpayment from prior year

Payment due with this coupon (Subtract Line 5 from Line 4)

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

STATE OF CONNECTICUT

Estimated Health Care Center Tax

DEPARTMENT OF REVENUE SERVICES

FOR CALENDAR YEAR ENDING

Payment Coupon

PO Box 2990 Hartford CT 06104-2990

(Rev. 12/00)

CT Health Care Center Tax Reg. No.

Tax shown on 2000 Form 207 HCC, Line 15

Multiply the tax that will be shown on 2001 Form HCC by 90% (.90)

Date Received (DRS USE ONLY)

Required annual payment (Enter the lesser of Line 1 or Line 2)

Federal Employer ID Number

Multiply Line 3 by 80% (.80)

Amount paid with Forms 207HCC ESA and 207 HCC ESB plus overpayment from

prior year

Payment due with this coupon (Subtract Line 5 from Line 4)

Please change

DUE DATE:

September 15

name or

mailing address,

MAKE CHECKS PAYABLE TO:

or both,

COMMISSIONER OF REVENUE SERVICES

if shown

MAIL TO:

Department of Revenue Services

incorrectly

Processing Section

at right

PO Box 2990

Hartford CT 06104-2990

207HCC ESD - Fourth Installment

207HCC ESD

STATE OF CONNECTICUT

Estimated Health Care Center Tax

DEPARTMENT OF REVENUE SERVICES

FOR CALENDAR YEAR ENDING

Payment Coupon

PO Box 2990 Hartford CT 06104-2990

(Rev. 12/00)

CT Health Care Center Tax Reg. No.

Tax shown on 2000 Form 207 HCC, Line 15

Multiply the tax that will be shown on 2001 Form 207 HCC by 90% (.90)

Date Received (DRS USE ONLY)

Required annual payment (Enter the lesser of Line 1 or Line 2)

Federal Employer ID Number

Amount paid with Forms 207HCC ESA, 207HCC ESB, and 207HCC ESC

plus overpayment from prior year

Payment due with this coupon (Subtract Line 4 from Line 3)

Please change

DUE DATE:

December 15

name or

MAKE CHECKS PAYABLE TO:

mailing address,

or both,

COMMISSIONER OF REVENUE SERVICES

if shown

MAIL TO:

Department of Revenue Services

incorrectly

Processing Section

at right

PO Box 2990

Hartford CT 06104-2990

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

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