Form It-613 - Claim For Environmental Remediation Insurance Credit - 2014

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New York State Department of Taxation and Finance
IT-613
Claim for Environmental Remediation Insurance Credit
Tax Law - Sections 23 and 606(ff)
Calendar-year filers, mark an X in the box:
Other filers enter tax period:
beginning
and ending
File a separate Form IT-613 with your personal income tax return, Form IT-201,
IT-203, IT-204, or IT-205 for each Certificate of Completion (CoC).
Identifying number as shown on return
Name(s) as shown on return
Schedule A – Brownfield site identifying information
(see instructions, Form IT-613-I)
A Enter the date of execution of the Brownfield Cleanup Agreement (BCA) for the brownfield site
for which you are claiming the credit
............................................................................... A
(mm-dd-yyyy)
B Enter the following information as listed on the CoC issued by the Department of Environmental
Conservation (DEC) for the qualified site
. Submit a copy of the CoC. Also submit a
(see instructions)
copy of the certification form for the environmental remediation insurance tax credit completed by the insurer.
Site name
Site location
Municipality
County
DEC region
Division of Environmental Remediation (DER) site number Date CoC was issued
C Mark an X in the box if you received notification from the Department of State that the qualified
site is located in a Brownfield Opportunity Area .................................................................................. C
Schedule B – Individuals (including sole proprietors), partnerships, and fiduciaries
1 Qualified environmental remediation insurance premiums paid
.......................
00
.
1
(see instructions)
2 Multiply line 1 by 50% (.50) ........................................................................................................
00
.
2
3 Enter the lesser of line 2 or $30,000 ...........................................................................................
00
.
3
Individuals and partnerships: Enter the line 3 amount on line 8.
Fiduciaries: Include the line 3 amount in the Total line of Schedule E, column C.
Schedule C – Partnership, S corporation, estate, and trust information
(see instructions)
If you were a partner in a partnership, a shareholder of a New York S corporation, or a beneficiary of an estate or trust and received a share of
the environmental remediation insurance credit from that entity, complete the following information for each partnership, New York S corporation,
estate, or trust. For Type, enter P for partnership, S for S corporation, or ET for estate or trust.
Name
Type
Employer ID number
Schedule D – Partner’s, shareholder’s, or beneficiary’s share of credit
(see instructions)
Enter your share of the credit from your partnership .......................................
00
Partner
4
.
4
S corporation
Enter your share of the credit from your S corporation ...................................
00
shareholder
.
5
5
Beneficiary
Enter your share of the credit from the estate or trust .....................................
00
6
.
6
................................................................................
00
.
7
Total
(add lines 4, 5, and 6)
7
Fiduciaries: Include the line 7 amount in the Total line of Schedule E, column C.
All others: Enter the line 7 amount on line 9.
173001140094

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