Form Nyc-210 - Claim For New York City School Tax Credit - 2012
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1
2New York State Department of Taxation and Finance
NYC-210
Claim for New York City School Tax Credit
Your first name and middle initial
Your last name
Your social security number
Your date of birth (mm-dd-yyyy)
(for a combined claim, enter spouse’s name on line below)
Spouse’s first name and middle initial Spouse’s last name
Spouse’s social security number
Spouse’s date of birth (mm-dd-yyyy)
Mailing address
Apartment number
You must enter your date(s) of
(number and street or rural route)
birth and social security number(s)
above.
City, village, or post office
State ZIP code
Country
NYS county of residence while living in NY City
(if not United States)
Address of New York City residence that qualifies you for this credit, if different from above
City
State
ZIP code
Taxpayer’s date of death Spouse’s date of death
Decedent
NY
information
Note: Use this form only if you are not required to file a 2012 Form IT-201 or IT-203, and you lived in New York City for any part of
2012. You lived in New York City if you lived in any of the following counties during 2012: Kings County (Brooklyn), Bronx, New
York County (Manhattan), Richmond County (Staten Island), or Queens. If you did not live in any of these counties for all or part of
the year, stop; you do not qualify for this credit.
Single
Married but filing a separate claim
Type of claim –
a
c
(complete lines 1, 2, and 5)
(complete lines 1, 2, and 5)
mark an X in one box
Married filing a combined claim
Qualifying widow(er) with dependent
(see instructions)
child
b
d
(complete lines 1 through 5)
(complete lines 1, 2, and 5)
1 Can you be claimed as a dependent on another taxpayer’s 2012 federal return? .............................
Yes
No
1
If you marked an X in box a, c, or d above, and marked the Yes box at line 1, stop;
you do not qualify for the credit. All other filers continue with line 2.
2 Enter, in the box (to the right, the number of months during 2012 that you lived in
months
(see Note above; also see instructions) ...............................................................................
New York City
2
If you marked an X in box b above, continue with line 3. All other filers continue with line 5.
3 Can your spouse be claimed as a dependent on another taxpayer’s 2012 federal return? ..............
Yes
No
3
If you marked an X in the Yes box at both lines 1 and 3, stop; you do not qualify for this
credit. All other filers continue with line 4.
4 Enter, in the box to the right, the number of months during 2012 your spouse lived in
.......................................................................
months
New York City
4
(see Note above; also see instructions)
:
(fill in line 6)
- or -
- or -
5 Mark one refund choice
direct deposit
debit card
paper check
(see instructions)
Direct deposit (see instructions): Complete the following to have your refund deposited directly to your bank account.
6
Routing
6b Account
Personal
Personal
Business
Business
6a
- or -
- or -
- or -
number
type:
checking
savings
checking
savings
Note: If the funds for your refund would go to an account
Account
6c
outside the U.S., mark an X in this box (see instructions) ...
number
Print designee’s name
Designee’s phone number
Personal identification
Third-party
number (PIN)
(
)
designee?
(see instr.)
E-mail:
Yes
No
Date
Taxpayer(s) must sign here
Paid preparer must complete
(see instr.)
Preparer’s signature
Preparer’s NYTPRIN
Your signature
Firm’s name (or yours, if self-employed)
Preparer’s PTIN or SSN
Your occupation
Address
Employer identification number
Spouse’s signature and occupation (if joint claim)
Mark an X if
Date
Daytime phone number
(
)
self-employed
E-mail:
E-mail:
File your claim as soon as you can after January 1, 2013. Mail your claim to:
STATE PROCESSING CENTER, PO BOX 61000, ALBANY NY 12261-0001.
210001120094
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