IT-2658-NYS
New York State Department of Taxation and Finance
Attachment to Form IT-2658
Report of Estimated Personal Income Tax for
Page
of
Nonresident Individuals
Legal name
Employer identification number
Allocation of estimated personal income tax to nonresident individual partners and shareholders
(attach
additional Form(s) IT-2658-NYS if necessary)
A
B
C
D
Amount of estimated personal
Name and
Partner’s/shareholder’s
Partner’s/shareholder’s
social security number
income tax paid on behalf of partner
address of partner/shareholder
percentage of ownership
or shareholder
(see instructions)
(see instructions)
Last name
0 0
%
First name and middle initial
Apartment number City, village, or post office
State
ZIP code
Mailing address
(number and street or rural route; see instructions)
Last name
0 0
%
First name and middle initial
Apartment number City, village, or post office
State
ZIP code
Mailing address
(number and street or rural route; see instructions)
Last name
0 0
%
First name and middle initial
Apartment number City, village, or post office
State
ZIP code
Mailing address
(number and street or rural route; see instructions)
Last name
0 0
%
First name and middle initial
Apartment number City, village, or post office
State
ZIP code
Mailing address
(number and street or rural route; see instructions)
Last name
0 0
%
First name and middle initial
Apartment number City, village, or post office
State
ZIP code
Mailing address
(number and street or rural route; see instructions)
Last name
0 0
%
First name and middle initial
Apartment number City, village, or post office
State
ZIP code
Mailing address
(number and street or rural route; see instructions)
Last name
0 0
%
First name and middle initial
Apartment number City, village, or post office
State
ZIP code
Mailing address
(number and street or rural route; see instructions)
0 0
Page total
..............................
(add column D amounts)
0321150094