Form It-611 - Claim For Brownfeld Redevelopment Tax Credit - 2005
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3IT-611
New York State Department of Taxation and Finance
Claim for Brownfield Redevelopment Tax Credit
Tax Law - Sections 21 and 606(dd)
2005 calendar-year filers, mark an X in the box:
Other filers enter tax period:
beginning
and ending
File this claim with your personal income tax return, Form IT-201, IT-203, IT-204, or IT-205.
Identifying number as shown on return
Name(s) as shown on return
Address of qualified brownfield property
A Enter the date of execution of the Brownfield Cleanup Agreement (BCA) for the property for which you
are claiming the credit.......................................................................................................................... A
B Enter the date the Certificate of Completion (CoC) was issued by the Department of Environmental
Conservation (DEC) for the qualified site or the date the CoC was transferred to you pursuant to
the transfer or sale of the qualified site. Attach a copy of the certificate to this form.......................... B
C 1) Is the property for which the CoC was issued by the DEC located in an environmental zone (EN-Zone)? ... C1
Yes
No
%
2) If Yes, enter the percent of qualified property located within an EN-Zone ............................................ C2
Schedule A — Credit components
Part 1 — Site preparation credit component
(see instructions)
A
B
C
Description of site preparation costs
Date cost paid or
Costs
incurred
(mm/dd/yy)
1 Total of column C amounts from attached list(s), if any...............................................................
1.
2 Add column C amounts
2.
...................................................................
(include any amount on line 1)
3 Applicable percentage
.......................
3.
%
(from Applicable percentage table on page 3 of the instructions)
4 Site preparation credit component
...................
4.
(multiply line 2 by line 3; fiduciaries, see instructions)
Part 2 — Tangible property credit component
(see instructions)
A
B
C
D
E
Description of qualified property
Principal use
Date placed
Life
Cost or other basis
in service
(list each item separately)
(years)
(mm/dd/yy)
5 Total of column E amounts from attached list(s), if any...............................................................
5.
6 Add column E amounts
...................................................................
6.
(include any amount on line 5)
7 Applicable percentage
7.
......................
%
(from Applicable percentage table on page 3 of the instructions)
8 Tangible property credit component
.................
8.
(multiply line 6 by line 7; fiduciaries, see instructions)
Please file this original scannable
1711050094
credit form with the Tax Department.
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