CT-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 NYS Pub 910)
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
NYS 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 claimed the tax-free NY area tax elimination credit and you had a 100% area allocation factor, mark an X in the box ..............
If you claimed the tax-free NY area excise tax on telecommunications credit and you had a 100% area 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
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; see instructions)
Form CT-3M/4M, line 51)
See page 2 for third-party designee, certification, and signature entry areas.
437001140094