Form Ct-183-M - Transportation And Transmission Corporation Mta Surcharge Return - 2012 Page 2
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1
2Page 2 of 2 CT-183-M (2012)
Part 2 — Corporations operating vessels in MCTD territorial waters
A
B
MCTD territorial waters
New York State territorial waters
24 Aggregate number of working days ......................................................... 24
25 MCTD allocation percentage
(divide line 24, column A, by line 24, column B;
........................................................................... 25
%
enter here and on line 2)
Designee’s name
Designee’s phone number
(print)
Third – party
Yes
No
(
)
designee
Designee’s e-mail address
(see instructions)
PIN
Certification: I certify that this return and any attachments are to the best of my knowledge and belief true, correct, and complete.
Printed name of authorized person
Signature of authorized person
Official title
Authorized
person
E-mail address of authorized person
Telephone number
Date
(
)
Firm’s name
Firm’s EIN
Preparer’s PTIN or SSN
Paid
(or yours if self-employed)
preparer
Signature of individual preparing this return
Address
City
State
ZIP code
use
only
E-mail address of individual preparing this return
Preparer’s NYTPRIN
Date
(see instr.)
See instructions for where to file.
402002120094
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