Form It-2658-Att - Attachment To Report Of Estimated Tax For Nonresident Individual Partners And Shareholders - 2012

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IT-2658-ATT
New York State Department of Taxation and Finance
Attachment to Report of Estimated Tax for
Nonresident Individual Partners and Shareholders
Page
of
Legal name
Employer identification number
Allocation of estimated tax to nonresident individual partners and shareholders
( attach additional Form(s) IT-2658-ATT if necessary )
Partner’s/shareholder’s first name and middle initial
Partner’s/shareholder’s last name
Social security number (SSN)
Mailing address
Apartment number
Amount of estimated tax paid on
( number and street or rural route; see instructions )
behalf of nonresident partner or
shareholder
Percentage of ownership
City, village or post office
State
ZIP code
00
%
Partner’s/shareholder’s first name and middle initial
Partner’s/shareholder’s last name
Social security number (SSN)
Mailing address
Apartment number
Amount of estimated tax paid on
( number and street or rural route; see instructions )
behalf of nonresident partner or
shareholder
Percentage of ownership
City, village or post office
State
ZIP code
00
%
Partner’s/shareholder’s first name and middle initial
Partner’s/shareholder’s last name
Social security number (SSN)
Mailing address
Apartment number
Amount of estimated tax paid on
( number and street or rural route; see instructions )
behalf of nonresident partner or
shareholder
Percentage of ownership
City, village or post office
State
ZIP code
00
%
Partner’s/shareholder’s first name and middle initial
Partner’s/shareholder’s last name
Social security number (SSN)
Mailing address
Apartment number
Amount of estimated tax paid on
( number and street or rural route; see instructions )
behalf of nonresident partner or
shareholder
Percentage of ownership
City, village or post office
State
ZIP code
00
%
Partner’s/shareholder’s first name and middle initial
Partner’s/shareholder’s last name
Social security number (SSN)
Mailing address
Apartment number
Amount of estimated tax paid on
( number and street or rural route; see instructions )
behalf of nonresident partner or
shareholder
Percentage of ownership
City, village or post office
State
ZIP code
00
%
00
Page total
.....
( add last column amounts )
0421120094

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