Form Ct-189-Wr - Claim For Refund Of Section 189 Tax And Tax Surcharges

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New York State Department of Taxation and Finance
CT-189-WR
Claim for Refund of Section 189
(8/00)
Tax and Tax Surcharges
Tax Law — Article 9, Section 189
Employer identification number
Social security number
For office use only
NG
Name
If address on
Date received
return is new,
Number and street
check box.
City or town
State
ZIP code
Location of headquarters
Business telephone number
(
)
Audit use
Type of organization:
Corporation
Partnership
Individual
Other:
Period
Enter period covered by this refund claim. From:
to
Schedule A — Refund of tax based on price differential
Part I — Refund of tax and tax surcharge collected by a regulated public utility
(sections 189 and 189-b)
Line A — Number of Mcf’s (1,000 cubic feet) of gas service imported by and delivered to you
in New York State during the period covered by this claim:
1 Section 189 tax and 189-b tax surcharge paid per utility bill .......................................................................
1
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7
2 Actual consideration paid for same period ................................................
2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7
3 Tax rate
............................................................................
3
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7
(see instructions)
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7
4 Tax due under section 189
....................................
4
(multiply line 2 by line 3)
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7
5 Tax surcharge due under section 189-b
5
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7
(multiply line 4 by the applicable rate)
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7
6 Total tax and tax surcharge due
......................................................................................
6
(add lines 4 and 5)
7 Refund
.................................................................................................................
7
(subtract line 6 from line 1)
Part II — Refund of metropolitan transportation business tax (MTA surcharge) collected by a regulated public utility
(section 189-a)
Line B — Number of Mcf’s (1,000 cubic feet) of gas service imported by and delivered to you in the Metropolitan Commuter Transportation
District (MCTD) during the period covered by this claim:
8 Section 189-a MTA surcharge paid per utility bill .........................................................................................
8
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7
9 Actual consideration paid for same period ................................................
9
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7
10 Adjusted MTA surcharge rate
..........................................
10
(see instructions)
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7
11 MTA surcharge due under section 189-a
..............................................................
11
(multiply line 9 by line 10)
12 Refund
................................................................................................................
12
(subtract line 11 from line 8)
Part III — Total refund of sections 189, 189-a, and 189-b tax and tax surcharges
13 Total refund
....................................................................................................................
13
(add lines 7 and 12)
Schedule B — Refund of the full amount of section 189, 189-a, and 189-b tax and tax surcharges
collected by a regulated public utility
14 Number of Mcf’s (1,000 cubic feet) of gas service upon which tax was collected during the period
covered by the refund claim .....................................................................................................................
14
15 Section 189 tax and 189-b tax surcharge per utility bill
.....................................................
15
(see instructions)
16 Number of Mcf’s of gas service upon which the metropolitan transportation tax (MTA surcharge) was
collected during the period covered by the refund ...................................................................................
16
17 Section 189-a MTA surcharge paid per utility bill
..............................................................
17
(see instructions)
18 Refund of sections 189, 189-a, and 189-b tax and tax surcharges
.............................
18
(add lines 15 and 17)

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