Form It-204-Ll - Partnership, Limited Liability Company, And Limited Liability Partnership Filing Fee Payment Form - 2012

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New York State Department of Taxation and Finance
IT-204-LL
Partnership, Limited Liability Company, and
Limited Liability Partnership
For calendar year 2012 or fiscal year
Filing Fee Payment Form
beginning
and ending
Identification number
Legal name
(see instructions)
Trade name of business if different from legal name above
Change of business information
Mark X here if you have changed your mailing
address and have not previously notified us
Address
(number and street or rural route)
(see instr.)
Date business started
City, village, or post office State
ZIP code
Contact person’s telephone number
(
)
Principal business activity
Enter your 2-digit special condition
code if applicable
.......
(see instructions)
Mark an X in the box identifying the entity for which you are filing this form
(mark only one box):
Regular partnership
Limited liability company (LLC) or limited liability partnership (LLP)
Part 1 — General information
(mark an X in the appropriate box(es))
Mark applicable box(es):
Amended Form IT-204-LL
Refund
Final Form IT-204-LL
(see instructions)
1 Did this entity have any income, gain, loss, or deduction derived from New York sources during
....................................................................................................................... Yes
No
the tax year?
(see instructions)
2 Did this entity have an interest in real property in New York State during the last three years? ...................... Yes
No
3 Has there been a transfer or acquisition of the controlling interest in the entity during the last three years? ..... Yes
No
If you answered No to question 1, stop; you do not owe a fee. Do not file this form.
Part 2 — Partnerships, and LLCs and LLPs treated as partnerships for federal income tax purposes
4 Enter the amount from line 15, column B, of the New York source gross income worksheet in
the instructions ..............................................................................................................................
.
4
00
5 NYS filing fee — Enter the amount from the appropriate filing fee table in the instructions .............
.
5
00
Make check or money order for the line 5 amount payable to NYS filing fee; write your
EIN and 2012 filing fee on the remittance and submit it with this form.
Part 3 — LLCs that are disregarded entities for federal income tax purposes
6 LLC disregarded entity: Enter the identification number (EIN or SSN)
of the entity or individual who will be reporting the income or loss ....
6
7 LLC disregarded entity NYS filing fee — Enter 25 on this line .....................................................
.
7
00
Make check or money order for $25 payable to NYS filing fee; write your EIN or SSN
and 2012 filing fee on the remittance and submit it with this form.
Certification: I certify that all information contained on this form is true and correct to the best of my knowledge and belief.
Date
  Sign here
  Paid preparer must complete
(see instr.)
Signature of general partner
Preparer’s signature
Preparer’s NYTPRIN
Firm’s name (or yours, if self-employed)
Preparer’s PTIN or SSN
Employer identification number
Address
Date
Daytime phone number
(
)
Mark an X if
E-mail:
self-employed
E-mail:
File this form with payment within 60 days after the last day of the tax year
.
(see instr.)
Mail to: STATE PROCESSING CENTER, PO BOX 15150, ALBANY NY 12212-5150.
For private delivery services, see instructions.
240001120094

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