Form Ct-189-Wr - Claim For Refund Of Section 189 Tax And Tax Surcharges (Page 2 of 2) in pdf

CT-189-WR (8/00) (back)

Schedule C — Refund of tax and tax surcharges to a co-generation facility that does not have a

section 189 direct pay permit

Part I — Refund of tax and tax surcharge collected by a regulated public utility based on price differential

(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:

19 Section 189 tax and 189-b tax surcharge paid per utility bill .......................................................................

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

20 Actual consideration paid for same period ................................................

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

21 Tax rate

............................................................................

(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

22 Tax due under section 189

................................

(multiply line 20 by line 21)

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

23 Tax surcharge due under section 189-b

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 22 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

24 Total tax and tax surcharge due

(add lines 22 and 23)

..................................................................................

25 Refund

..............................................................................................................

(subtract line 24 from line 19)

Part II — Refund of MTA surcharge based on price differential 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 MCTD during the period covered by this claim:

26 Section 189-a MTA surcharge paid per utility bill .........................................................................................

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

27 Actual consideration paid for same period ................................................

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

28 Adjusted MTA surcharge 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

(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

29 MTA surcharge due under section 189-a

.............................................................

(multiply line 27 by line 28)

30 Refund

..............................................................................................................

(subtract line 29 from line 26)

Part III — Refund for co-generation facilities exemption

(sections 189 and 189-b)

31 BTU value of electricity and steam supplied to thermal energy host ...........................................................

32 BTU value of total electricity and steam produced by the co-generator ......................................................

33 Exemption percentage

..........................................

(divide line 31 by line 32; enter result to two decimal places)

34 Section 189 tax and 189-b tax surcharge paid for refund period

......................................

(see instructions)

35 Refund

......................................................................................

(multiply line 34 by the percentage on line 33)

Part IV — Refund for co-generation facilities exemption (MCTD)

(section 189-a)

36 BTU value of electricity and steam supplied to thermal energy host in the MCTD .....................................

37 BTU value of total electricity and steam produced by the co-generator in the MCTD .................................

38 Exemption percentage

..........................................

(divide line 36 by line 37; enter result to two decimal places)

39 Section 189-a MTA surcharge paid for refund period

........................................................

(see instructions)

40 Refund

......................................................................................

(multiply line 39 by the percentage on line 38)

Part V — Total refund of section 189, 189-a, and 189-b tax and tax surcharge to co-generators

41 Total refund

......................................................................................................

(add lines 25, 30, 35, and 40)

Schedule D — Refund of tax for any other reason (Attach your revised tax computation and a

computation of your refund)

In accordance with Article 27, section 1087, of the Tax Law, I make the following claim for credit or refund of tax paid.

Tax period ending ................................................

Amount of claim .................................................. $

Reason for claim .................................................

Certification. I certify that this return and any attachments are to the best of my knowledge and belief true, correct, and complete.

Signature of elected officer or authorized person

Official title

Date

Firm’s name

ID number

Date

(or yours if self-employed)

Address

Signature of individual preparing this return

Mail this return to: NYS TAX DEPARTMENT, TTTB — FACCTS, BUILDING 8, W A HARRIMAN CAMPUS, ALBANY NY 12227

Form Ct-189-Wr - Claim For Refund Of Section 189 Tax And Tax Surcharges Page 2

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