Form Ct-33-C - Captive Insurance Company Franchise Tax Return - 2014

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CT-33-C
New York State Department of Taxation and Finance
Captive Insurance Company
Franchise Tax Return
Tax Law – Article 33
All filers must enter tax period:
beginning
ending
Amended 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
Foreign corporations: date began
City
State
ZIP code
business in NYS
NAICS business code number
(from NYS Pub 910)
If address/phone
Audit (for Tax Department use only)
If you need to update your address or phone
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.
Federal return was filed on (mark an X in one):
1120-L
1120-PC
Consolidated
Other:
Payment enclosed
A. Pay amount shown on line 19. Make payable to: New York State Corporation Tax
Attach your payment here. Detach all check stubs.
(See instructions for details.)
A
Computation of tax and installment payments of estimated tax
(see instructions)
Tax on New York State gross direct premiums
(see instr.)
1 First $20,000,000 of gross direct premiums ..................
× .004
1
2 $20,000,001-$40,000,000 of gross direct premiums ....
× .003
2
3 $40,000,001-$60,000,000 of gross direct premiums ....
3
× .002
4 Excess of $60,000,000 of gross direct premiums .........
× .00075
4
Tax on New York State reinsurance premiums
(see instr.)
5 First $20,000,000 of reinsurance premiums ..................
5
× .00225
6 $20,000,001-$40,000,000 of reinsurance premiums ....
× .0015
6
7 $40,000,001-$60,000,000 of reinsurance premiums ....
× .0005
7
8 Excess of $60,000,000 of reinsurance premiums ..........
8
× .00025
Computation of tax and estimated tax due
9 Tax due based upon premiums
.....................................................................
9
(add lines 1 through 8)
10 Minimum tax .....................................................................................................................................
10
5,000 00
11 Tax due
11
............................................................................................
(enter the greater of line 9 or 10)
First installment of estimated tax for next period:
12a If you filed a request for extension, enter amount from Form CT-5, line 2 .....................................
12a
12b If you did not file Form CT-5, see instructions ...............................................................................
12b
13 Total
...................................................................................................
13
(add line 11 and line 12a or 12b)
14 Total prepayments from line 27.......................................................................................................
14
15 Balance
15
..........................................................
(if line 14 is less than line 13, subtract line 14 from line 13)
16 Estimated tax penalty
16
..............
(see instructions; mark an X in the box if Form CT-222 is attached)
17 Interest on late payment
........................................................................................
17
(see instructions)
18 Late filing and late payment penalties
...................................................................
18
(see instructions)
19 Balance due
19
..........
(add lines 15 through 18 and enter here; enter the payment amount on line A above)
20 Overpayment
..............................................
20
(if line 13 is less than line 14, subtract line 13 from line 14)
21 Amount of overpayment to be credited to next period ..................................................................
21
22 Refund of overpayment
22
........................................................................
(subtract line 21 from line 20)
Continued on page 2
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