Form Ct-207k - Insurance/health Care Tax Credit Schedule - 2014
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1
2
3Department of Revenue Services
Form CT-207K
2014
State of Connecticut
Insurance/Health Care Tax Credit Schedule
(Rev. 06/14)
Complete this form in blue or black ink only.
Name of Company
Connecticut Tax Registration Number
Part 1 - 30% Tax Credit Limitation
00
1. Amount of tax from Form 207, Line 4; Form 207F, Line 11; or Form 207HCC, Line 13.
00
2. Part 1 - 30% Tax Credit Limitation: Multiply Line 1 by 30% (.30).
C
D
E
A
B
Part 1A - Tax Credits With Carryback
Amount Applied
Carryforward Amount to 2015
Carryback Amount
Carryforward Amount From
2014 Credit Amount Claimed
Provisions
Previous Income Years
00
00
00
3. Neighborhood Assistance
00
00
00
00
00
4. Housing Program Contribution - Form CT-1120 HPC
5. Total Part 1A. Add Line 3 and Line 4. The total from
00
00
00
00
00
Column C must not exceed amount from Line 2.
Part 1B - Tax Credits Without Carryback or Carryforward Limitation
00
6. Part 1B - Tax Credit Without Carryback or Carryforward Limitation: Subtract Line 5, Column C from Line 2.
A
B
C
D
E
Carryforward Amount From
2014 Credit Amount Claimed
Amount Applied
Carryforward Amount to 2015
Carryback Amount
Previous Income Years
7. Reserved for future use
00
00
8. New Jobs Creation - Form CT-1120 NJC
00
00
9. Insurance Department Assessment
00
00
10. Qualifi ed Small Business Job Creation - Form CT-1120 SBJ
11. Reserved for future use
00
00
12. Job Expansion - Form CT-1120 JET
13. Total Part 1B. Add Lines 7 through 12. The total from
00
00
Column C must not exceed amount from Line 6.
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