Form Ct-5.3 - Request For Six-Month Extension To File - 2012 Page 2
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2Page 2 of 2 CT-5.3 (2012)
Combined filer information
Part 1 — Member corporations
(attach additional sheets if necessary, formatted as below)
A
B
C
D
E
F
G
Employer
Subsidiary
Prior year
Total CT-400
Amount paid
Member corporation name
Short tax year
identification
fixed
payments
payments
with a separately
from
to
number
dollar
filed CT-5 or
(mm-yy) (mm-yy)
minimum tax
CT-5.4 extension
15 Add amounts in Part 1, column D ........................................... 15
Part 2 — Parent or payor corporation only
E
F
Prior year payments
Total CT-400 payments
16 Parent or payor corporation’s prepayments ....................................................
16
Composition of prepayments —
Use the following worksheet to determine the prepayments
A
B
of franchise tax on line 7 and the prepayments of the MTA surcharge on line 12 (see instructions).
Combined franchise tax Combined MTA surcharge
Date paid
Amount
Amount
Composition of prepayments claimed on lines 7 and 12
17 Mandatory first installment of combined group ...........
17
18a Second installment of combined group from
Form CT-400 ............................................................. 18a
18b Third installment of combined group from
Form CT-400 ............................................................. 18b
18c Fourth installment of combined group from
Form CT-400 ............................................................ 18c
19 Overpayment credited from combined return of prior years ...................... 19
20 Overpayment credited from Form CT-
20
......
Period
21 Total prepayments from member not previously included in the
combined return ...................................................................................... 21
22 Total prepayments
........................ 22
(total all entries in column A and column B)
Firm’s name
Firm’s EIN
Preparer’s PTIN or SSN
(or yours if self-employed)
Paid
preparer
Signature of individual preparing this document
Address
City
State
ZIP code
use
only
E-mail address of individual preparing this document
Preparer’s NYTPRIN
Date
(see instr.)
See instructions for where to file.
456002120094
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