Form Ct-612 - Claim For Remediated Brownfield Credit For Real Property Taxes - 2013

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New York State Department of Taxation and Finance
CT-612
Claim for Remediated Brownfield Credit
For Real Property Taxes
Tax Law – Article 9, Section 187-h; Article 9-A, Section 210.34;
Article 32, Section 1456(r); and Article 33, Section 1511(v)
All filers must enter tax period:
beginning
ending
Legal name of corporation filing franchise tax return
Employer identification number (EIN)
Address of qualified brownfield site
File this form with your franchise tax return. A separate Form CT-612 must be filed for each Certificate of Completion (COC).
Enter the date of execution of the Brownfield Cleanup Agreement (BCA) for the brownfield site
for which you are claiming this credit ..............................................................................................
(see instructions)
....................................
A
A Mark an X in the box if you are claiming this credit as a corporate partner
Schedule A – Brownfield site identifying information
(see instructions)
Enter the following information as listed on the COC issued by the Department of Environmental Conservation (DEC) for
the qualified site. Attach a copy of the COC.
Site name
Site location - municipality
Site location - county
DEC region
Division of Environmental Remediation (DER) site number
Date COC was issued
Mark an X in the box if you received notification from the Department of State that the qualified site is
located in a Brownfield Opportunity Area ........................................................................................................................
If applicable, enter the date the COC was transferred pursuant to the transfer or sale of the
qualified site. Attach a copy of the sale or transfer documentation to this form.............................
Is the qualified site for which the COC was issued by the DEC located entirely within
an environmental zone (EN-Zone)? . ...................................................................................................................... Yes
No
Schedule B – Computation of average number of full-time employees employed by a developer and a lessee
(see instr.)
March 31
June 30
September 30
December 31
Total
................
(if less than 25, no credit is allowed; see instructions)
1 Average number of full-time employees
1
Schedule C – Computation of remediated brownfield credit for real property taxes
......................................................................................
(see instructions)
2 Employment number factor
2
3 Eligible real property taxes
........................................................................................
3
(see instructions)
4 Enter 0.25
..........................................
4
(if the qualified site is located entirely within an EN-Zone, enter 1.0)
5 Remediated brownfield credit for real property taxes
. ........................
5
(multiply line 2 by line 3 by line 4)
6 Recapture of remediated brownfield credit for real property taxes
..........................
(see instructions)
6
7 Remediated brownfield credit for real property taxes after recapture
.......................
7
(see instructions)
8 Limitation of remediated brownfield credit for real property taxes
.................
8
(multiply 10,000 by line 1)
9 Remediated brownfield credit for real property taxes after limitation
9
(enter the lesser of line 7 or line 8)
10 Remediated brownfield credit for real property taxes from partnerships
. .................
10
(see instructions)
11 Total remediated brownfield credit for real property taxes
(add lines 9 and 10; New York S corporations
.................................................................................................................................
see instructions )
11
520001130094

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