Form Ct-13 - Unrelated Business Income Tax Return - New York State Department Of Taxation And Finance - 2012 Page 2

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Page 2 of 3 CT-13 (2012)
Have you been audited by the Internal Revenue Service in the past 5 years? Yes
No
If Yes, list years:
Attach a complete copy of your federal return.
Federal return was filed on:
990-T
Other:
Schedule A – Unrelated business allocation
If you did not maintain a regular place of business outside New York State, leave this schedule blank. A regular place of
business is any office, factory, warehouse, or other space regularly used by the taxpayer in its unrelated business. If you
claim this allocation, attach a list of each place of business, the location, nature of activities, and number and duties of employees.
A
B
Average value of:
New York State
Everywhere
26 Real estate owned
26
..........................................
(see instructions)
27 Gross rents
27
......................................
(attach list; see instructions)
28 Inventories owned ....................................................................
28
29 Other tangible personal property owned
........
29
(see instructions)
30 Total
30
....................................................
(add lines 26 through 29)
31 Percentage in New York State
........................................................
31
%
(divide line 30, column A, by line 30, column B)
Receipts in the regular course of business from:
32 Sales of tangible personal property shipped to points within
New York State .....................................................................
32
33 All sales of tangible personal property .....................................
33
34 Services performed ..................................................................
34
35 Rentals of property ..................................................................
35
36 Other business receipts ...........................................................
36
37 Total
....................................................
37
(add lines 32 through 36)
38 Percentage in New York State
.........................................................
%
(divide line 37, column A, by line 37, column B)
38
39 Wages, salaries, and other compensation of employees
(
....................
39
except general executive officers; see instructions)
40 Percentage in New York State
40
%
........................................................
(divide line 39, column A, by line 39, column B)
41 Total of New York State percentages
.........................................................................
41
%
(add lines 31, 38, and 40)
42 Business allocation percentage
........................................
42
%
(divide line 41 by three or by the number of percentages)
Composition of prepayments claimed on line 18*
Date paid
Amount
43 Payment with extension request, Form CT-5, line 5 ...............................................
43
44a Second installment from Form CT-400 ................................................................... 44a
44b Third installment from Form CT-400 ....................................................................... 44b
44c Fourth installment from Form CT-400 ..................................................................... 44c
45 Amount of overpayment credited from prior years ..............................................................................
45
46 Total prepayments
......................................................
46
(add lines 43 through 45; enter here and on line 18)
*
Taxpayers subject to the unrelated business income tax are not required to make estimated tax payments.
If you did make these unrequired payments, report them on lines 44a, 44b, and 44c.
Amended return information
If filing an amended return, mark an X in the box for any items that apply and attach documentation.
Final federal determination ...............
If marked, enter date of determination:
Net operating loss (NOL) carryback ...
Capital loss carryback ...............................................................
Federal return filed ......... Form 1139
Amended Form 990-T ...............................................................
400002120094

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