Form It-2658 - Report Of Estimated Tax For Nonresident Individual Partners And Shareholders - 2013

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IT-2658
New York State Department of Taxation and Finance
Report of Estimated Tax for Nonresident
1
Page
of
Individual Partners and Shareholders
For Payments on Behalf of Nonresident Individuals Only
Due date
: April 15, 2013
June 17, 2013
September 16, 2013
January 15, 2014
(mark an X in one box)
Mark an X in the
Employer identification number
Legal name
box if filer is an
S corporation ........
Trade name of business if different from legal name above
Total number of partners/shareholders from
all Form(s) IT‑2658 and IT‑2658‑ATT
Address (number and street or rural route; see instructions, Form IT‑2658‑I)
T
otal New York
00
source income ....
City, village, or post office
State
ZIP code
Total estimated
tax paid from all
Form(s) IT‑2658
Contact name
Contact phone number
00
and IT‑2658‑ATT
(
)
Contact e‑mail address
Allocation of estimated tax to nonresident individual partners and shareholders
(attach Form(s) IT-2658-ATT if necessary)
Partner’s/shareholder’s first name and middle initial
Partner’s/shareholder’s last name
Social security number (SSN)
Mailing address
Apartment number
Amount of estimated tax paid on
(number and street or rural route; see instructions)
behalf of nonresident partner or
shareholder
Percentage of ownership
City, village or post office
State
ZIP code
00
%
Partner’s/shareholder’s first name and middle initial
Partner’s/shareholder’s last name
Social security number (SSN)
Mailing address
Apartment number
Amount of estimated tax paid on
(number and street or rural route; see instructions)
behalf of nonresident partner or
shareholder
Percentage of ownership
City, village or post office
State
ZIP code
00
%
Partner’s/shareholder’s first name and middle initial
Partner’s/shareholder’s last name
Social security number (SSN)
Mailing address
Apartment number
Amount of estimated tax paid on
(number and street or rural route; see instructions)
behalf of nonresident partner or
shareholder
Percentage of ownership
City, village or post office
State
ZIP code
00
%
00
Page total
......
(add last column amounts)
Signature of general partner or member, elected officer, or
 
Paid preparer must complete (see instructions)
Date:
authorized person
Preparer’s NYTPRIN
Preparer’s signature
Sign
Preparer’s PTIN or SSN
Firm’s name (or yours, if self-employed
)
here
Date
Daytime phone number
Address
Employer identification number
(
)
Mark an X if
self‑employed
E‑mail:
Mail this form to:
NYS ESTIMATED INCOME TAX, PROCESSING CENTER, PO BOX 4123, BINGHAMTON NY 13902-4123
0411130094

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