Form Ct-33 - Life Insurance Corporation Franchise Tax Return - 2014
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7CT-33
New York State Department of Taxation and Finance
Life Insurance Corporation
Franchise Tax Return
Tax Law — Article 33
All filers must enter tax period:
beginning
ending
Amended return
Final return
Employer identification number (EIN)
File number
Business telephone number
If you claim an
overpayment, mark
(
)
an X in the box
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
City
State
ZIP code
Foreign corporations: date began
business in NYS
NAICS business code number
If address/phone
If you need to update your address or phone
Audit (for Tax Department use only)
(from NYS Pub 910)
above is new,
information for corporation tax, or other tax
mark an X in the box
types, you can do so online. See Business
NYS principal business activity
information in Form CT‑1.
During the tax year did you do business, employ capital, own or lease property, or maintain an office in the
Metropolitan Commuter Transportation District? If Yes, you must file Form CT‑33‑M
................... Yes
No
(see instructions)
Payment enclosed
A. Pay amount shown on line 21. Make payable to: New York State Corporation Tax
Attach your payment here. Detach all check stubs.
(See instructions for details.)
A
B. Federal return filed:
Attach a complete copy of your federal return.
(mark an X in one box)
Form 1120‑L
Form 1120‑PC
Consolidated basis
Other:
Have you been audited by the Internal Revenue Service in the past 5 years? ............................................ Yes
No
If Yes, list years:
Name
EIN
Enter primary corporation name and EIN
(if a member of an affiliated federal group):
Name
EIN
Enter parent corporation name and EIN
(if more than 50% owned by another corporation):
C. Did you include a disregarded entity in this return?
.................................. Yes
No
(mark an X in the appropriate box)
If Yes, enter the name and EIN below. If more than one, attach list with names and EINs.
Legal name of disregarded entity
EIN
D. Are you a residual interest holder in a real estate mortgage investment conduit (REMIC)? ........................ Yes
No
E. If this corporation is an unauthorized insurance corporation, mark an X in the box ....................................................................
Attach a copy of your complete federal return, a copy of your Annual Report of Premiums and Exhibit of Premiums and Losses
(New York) as filed with the New York State Department of Financial Services, and copies of the following schedules from your Annual
Statement: Assets; Liabilities, Surplus and Other Funds; the Summary by Country portion of Schedule D; the Exhibit of Premiums
Written, Schedule T; and Reinsurance Assumed, Part 1 of Schedule S.
See page 7 for third‑party designee, certification, and signature entry areas.
426001140094
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