Form Tr-193 - Affidavit For Corporate Dissolution For Domestic Corporations
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1TR-193
(7/15)
Office of Processing and Taxpayer Services
W A Harriman Campus, Albany NY 12227-0852
Affidavit for Corporate Dissolution for Domestic Corporations
Corporation name:
Corporation EIN:
, being duly sworn, hereby deposes and says:
1. I am the
(Title)
of
(Corporation name)
2. The corporation requests dissolution as of
(mm-dd-yy)
3. The corporation’s estimated tax and MTA surcharge for the period beginning
(mm-dd-yy)
and ending
is computed as follows:
(mm-dd-yy)
Tax before credits by tax base – you must attach a schedule showing the computation of each tax base
Estimated business income base liability:
Estimated capital base liability:
Estimated fixed dollar minimum tax:
Estimated tax credits to be used – you must attach a schedule showing a breakdown of credits by name and
dollar amount
(if applicable)
Total amount of credits to be used:
Estimated tax after credits:
MTA surcharge – you must attach a schedule showing the computation of the MTA surcharge
(if applicable)
Are you subject to the MTA surcharge?
Yes
No
If Yes, estimated MTA surcharge:
Total estimated tax and MTA surcharge:
4. I acknowledge that this corporation is required to file a final New York State tax return and MTA surcharge return (if
applicable), and pay any additional tax and surcharge due, no later than 30 days after the appropriate tax forms are
made available on the Tax Department’s Web site.
5. I acknowledge that this corporation must satisfy all open liability periods prior to consent being issued.
6. I certify that the foregoing statements are true and correct to the best of my knowledge and belief.
Signature
Notary acknowledgement
Sworn to before me this
day of
, 20
Notary stamp
Notary Public
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Parent category: Financial