Form Ct-33-A/att - Schedules A, B, C, D, And E - Attachment To Form Ct-33-A - Life Insurance Corporation Combined Franchise Tax Return - 2012 Page 3
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3CT-33-A/ATT (2012) Page 3 of 3
Schedule D — Computation of adjustment for gains or losses on disposition of property acquired before
January 1, 1974
(you may no longer report gain or loss in the same manner you report it on your federal income tax return)
A
B
C
D
E
F
Description of property
Cost
Fair market
Value realized
New York
Federal
price or value
on disposition
gain or loss
gain or loss
(attach separate sheet if necessary)
on Jan. 1, 1974
Totals from attached sheet ..
9 Totals
9
.......................................................................
(add amounts in columns E and F)
10 New York adjustment
(subtract line 9, column F, from line 9, column E; enter here and on line 68 of
.....................................................
10
Form CT-33-A or Form CT-33-A/B; use a minus sign for negative amounts)
Schedule E — Officers (appointed or elected) and certain stockholders
(include all officers, whether or not receiving any
compensation, and all stockholders owning more than 5% of taxpayer’s issued capital stock who received any compensation)
A
B
C
D
Name and address
Social security
Official title
Salary and all other
number
compensation received
(give actual residence;
from corporation
attach separate sheet if necessary)
Totals from attached sheet ........................................................................................................................................
11 Totals (
..........................
11
add column D amounts; enter here and on line 87 of Form CT-33-A or Form CT-33-A/B)
Certification: Under the penalties of perjury, I declare that this corporation is allowed to file on a combined basis under New York
State Law and is also liable for the group tax liability, and I certify that this return and any attachments are to the best of my knowledge
and belief true, correct, and complete.
Printed name of authorized person
Signature of authorized person
Official title
Authorized
person
E-mail address of authorized person
Telephone number
Date
(
)
Firm’s name
Firm’s EIN
Preparer’s PTIN or SSN
Paid
(or yours if self-employed)
preparer
Signature of individual preparing this return
Address
City
State
ZIP code
use
only
E-mail address of individual preparing this return
Preparer’s NYTPRIN
Date
(see instr.)
499003120094
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