Form It-2658-Mta - Report Of Estimated Metropolitan Commuter Transportation Mobility Tax (Mctmt) For Nonresident Individual Partners - 2015 Page 2

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IT-2658-MTA (2015) (back)
Legal name
Employer identification number
Page
of
A
B
C
D
Amount of estimated MCTMT
Name and
Partner’s
Partner’s percentage
social security number
paid on behalf of partner
address of partner
of ownership
(see instructions)
(see instructions)
Last name
0 0
%
First name and middle initial
Mailing address
Apartment number City, village, or post office
State
ZIP code
(number and street or rural route; see instructions)
Last name
0 0
%
First name and middle initial
Mailing address
Apartment number City, village, or post office
State
ZIP code
(number and street or rural route; see instructions)
Last name
0 0
%
First name and middle initial
Mailing address
Apartment number City, village, or post office
State
ZIP code
(number and street or rural route; see instructions)
Last name
0 0
%
First name and middle initial
Mailing address
Apartment number City, village, or post office
State
ZIP code
(number and street or rural route; see instructions)
Last name
0 0
%
First name and middle initial
Mailing address
Apartment number City, village, or post office
State
ZIP code
(number and street or rural route; see instructions)
Last name
0 0
%
First name and middle initial
Mailing address
Apartment number City, village, or post office
State
ZIP code
(number and street or rural route; see instructions)
Last name
0 0
%
First name and middle initial
Mailing address
Apartment number City, village, or post office
State
ZIP code
(number and street or rural route; see instructions)
0 0
Page total
..............................
(add column D amounts)
0324150094

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