Form Nyc-3a - Combined General Corporation Tax Return - 2017 Page 10
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12Form NYC-3A - 2017
: _______________________________________________
: ________________________
Page 10
NAME OF REPORTING CORPORATION
EIN
A D D I T I O N A L I N F O R M AT I O N R E Q U I R E D
The following information must be entered for this return to be complete.
1a. New York City principal business activity ___________________________________________________________________________________________
1b. Other significant business activities (attach schedule, see instructions) ___________________________________________________________________
1c. Trade name of reporting corporation, if different from name entered on page 1 _____________________________________________________________
2. have there been any changes in the composition of the group of corporations included in this Combined General Corporation
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Tax Return from the prior Tax Period? .....................................................................................................................................................
YES
NO
If "YES", complete Part III and/or Part IV of the Affiliations Schedule on page 12 of this Form NYC-3A.
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3. Is only one subsidiary included in this return? ...........................................................................................................................................
YES
NO
If "YES", give name of corporation:___________________________________________________
EIN: _______________________________________
4. Is any member corporation also a member of a controlled group of corporations as defined in IRC section 1563,
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disregarding any exclusion by reason of paragraph (b)(2) of that section? .............................................................................................
YES
NO
EIN _______________________________
If "YES", give common parent corporation’s name, if any__________________________________
5. has the Internal Revenue Service or the New York State Department of Taxation and Finance corrected any taxable income or
other tax base reported in a prior year, for the combined group, any variation of the combined group or any member corporation
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or are any of the same currently under audit? ..........................................................................................................................................
YES
NO
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If "YES", by whom?
State period(s): Beg.:________________
End.:________________
Internal Revenue Service
MMDDYY
MMDDYY
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State period(s): Beg.:________________
End.:________________
New York State Department of Taxation and Finance
MMDDYY
MMDDYY
6. If “YES” to question 5, has Form(s) NYC-3360 (Report of Federal/State Change in Tax Base) been filed?
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Only applicable for years prior to 1/1/15. For years beginning on or after 1/1/15, file an amended return. (see instructions)....................
YES
NO
7. Did any member corporation make any payments treated as interest in the computation of entire net income to shareholders
owning directly or indirectly, individually or in the aggregate, more than 50% of the corporation’s issued and
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outstanding capital stock? If “YES”, complete the following (if more than one, attach separate sheet) ....................................................
YES
NO
Shareholder’s name: ______________________________________________________
SSN/EIN: ________________________________________
_____________
_____________
: _____________
Interest paid to Shareholder:
Total Indebtedness to shareholder described above:
Total interest paid
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8. Was any member corporation also a member of a partnership or joint venture during the tax year? ........................................................
YES
NO
If "YES", attach schedule listing name(s) and Employer Identification Number(s).
9. At any time during the taxable year, did any member corporation have an interest in real property (including a leasehold interest)
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located in NYC or a controlling interest in an entity owning such real property? ........................................................................................
YES
NO
10. a) If "YES" to 9, attach a schedule of such property, indicating owning corporation, the nature of the interest and including the street address, borough, block and lot number.
b) Was any NYC real property (including a leasehold interest) or controlling interest in an entity owning NYC real
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property acquired or transferred with or without consideration? .............................................................................................................
YES
NO
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c) Was there a partial or complete liquidation of the owning corporation? .................................................................................................
YES
NO
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d) Was 50% or more of the owning corporation’s ownership transferred during the tax year, over a three-year period or according to a plan? ................
YES
NO
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11. If "YES" to 10b, 10c or 10d, was a Real Property Transfer Tax Return (Form NYC-RPT) filed?................................................................
YES
NO
12. If "NO" to 11, explain: _________________________________________________________________________________________
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13. Does any member corporation have one or more qualified subchapter S subsidiaries? ...........................................
YES
NO
If “YES”: Attach a schedule showing the name, address and EIN, if any, of each QSSS and indicate whether
the QSSS filed or was required to file a City business income tax return. (see instructions)
14. Enter the number of Fed K1 returns attached:____________________________________
15. Does any member corporation pay rent greater than $200,000 for any premises in NYC in the borough of Manhattan
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south of 96th Street for the purpose of carrying on any trade, business, profession, vocation or commercial activity? ......
YES
NO
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16. If "YES," were all required Commercial Rent Tax Returns filed? ...............................................................................
YES
NO
Attach schedule listing name of member corporation(s) and Employer Identification Number(s) which was used on the Commercial Rent Tax Return(s).
C E R T I F I C AT I O N O F A N E L E C T E D O F F I C E R O F T H E C O R P O R AT I O N
I hereby certify that this return, including any accompanying rider, is, to the best of my knowledge and belief, true, correct and complete.
I authorize the Dept. of Finance to discuss this return with the preparer listed below. (see instructions) ....YES
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S
IGN
Signature of officer
Title
Date
:
HERE
t PREPARER USE ONLY t
n
Preparer's
Preparer’s
Check if self-
signature
printed name
employed 4
Date
s Firm's name
s Address
s Zip Code
(or yours, if self-employed)
Preparer's Social Security Number or PTIN
Firm's Employer Identification Number
Firm's Email Address
301101791
_________________________________________________
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