Form Ct-3-A/c - Report By A Corporation Included In A Combined Franchise Tax Return - New York State Department Of Taxation And Finance - 2012
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1
2CT-3-A/C
New York State Department of Taxation and Finance
Report by a Corporation Included in a
Combined Franchise Tax Return
All filers must enter tax period:
Tax Law — Article 9-A
beginning
ending
Final return
Employer identification number (EIN)
File number
Business telephone number
(
)
Legal name of corporation
Trade name/DBA
State or country of incorporation
Date received (for Tax Department use only)
Mailing name (if different from legal name above)
c/o
Date of incorporation
Number and street or PO box
Foreign corporations: date began
City
State
ZIP code
business in NYS
NAICS business code number
If address/phone
Audit (for Tax Department use only)
(from federal return)
If you need to update your address or
above is new,
phone information for corporation tax, or
mark an X in the box
other tax types, you can do so online. See
Principal business activity
Business information in Form CT-1.
Combined parent’s corporation legal name
Combined parent’s EIN
Combined issuer’s allocation percentage
(from CT-3-A, line B)
%
Metropolitan transportation business tax (MTA surcharge) — During the tax year, did you do business, employ
capital, own or lease property, or maintain an office in the Metropolitan Commuter Transportation District (MCTD)?
.................................................................................................................................. Yes
No
(mark an X in the appropriate box)
If you are a real estate investment trust (REIT) or regulated investment company (RIC), mark an X in the box
............
(see instructions)
If you claimed the QEZE tax reduction credit and you had a 100% zone allocation factor, mark an X in the box .................................
If you are an overcapitalized captive insurance company, mark an X in the box ..................................................................................
Fixed dollar minimum tax
(see instructions)
1a New York receipts
...................................................
1a
(see instructions)
1b Fixed dollar minimum tax
..........................................................
(only for the corporation filing this form)
1b
2 Corporations organized outside New York State must complete the following for capital stock issued and outstanding:
Number of par shares
Value
Number of no-par shares
Value
$
$
Composition of prepayments
(see instructions)
Franchise tax
MTA surcharge
Date paid
Amount
Date paid
Amount
3 Mandatory first installment
3
3
..............
4a Second installment from Form CT-400
4a
.............. 4a
4b Third installment from Form CT-400
4b
.............. 4b
4c Fourth installment from Form CT-400
4c
.............. 4c
5 Payment with extension request
5
5
..............
6 Credit from prior years
.........
6
.................................
6
(see instructions)
7 Add amount columns
(enter here and include
(enter here and include on
7
7
on Form CT-3-A, line 107)
Form CT-3M/4M, line 51)
Designee’s name
Designee’s phone number
(print)
Third – party
Yes
No
(
)
designee
Designee’s e-mail address
(see instructions)
PIN
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 report 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 report
Address
City
State
ZIP code
use
only
E-mail address of individual preparing this report
Preparer’s NYTPRIN
Date
(see instr.)
Attach this report to the parent corporation’s Form CT-3-A.
437001120094
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