Form Dtf-622 - Claim For Qetc Capital Tax Credit - 2012

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New York State Department of Taxation and Finance
DTF-622
Claim for QETC Capital Tax Credit
Tax Law – Articles 9-A and 22
All filers must enter tax period: beginning
ending
Name(s) as shown on return
Taxpayer identification number
File this form with corporation franchise tax return Form CT-3, CT-3-A, CT-3-S, or
personal income tax return Form IT-201, IT-203, IT-204, or IT-205.
Line A – Partner in a partnership, shareholder of a New York S corporation, or beneficiary of
an estate or trust: enter your share of the qualified emerging technology company (QETC)
A
capital tax credit
.....................................................
(see instructions, Form DTF-622-I, for assistance)
Taxpayer identification number
Business name of partnership, S corporation, estate, or trust
Schedule A – Computation of credit
Computation of credit for qualified investments to be held four years
Part 1
(Attach additional sheets if necessary.)
A
B
C
D
Name of certified QETC
EIN
Date of investment
Amount of investment
1 Amount of qualified investments
...........................................................
1
(add column D amounts)
2 Credit percentage (10%) .............................................................................................................
2
10
3 Credit for qualified investments to be held four years
....
(multiply line 1 by line 2; see instructions)
3
Computation of credit for qualified investments to be held nine years
Part 2
(Attach additional sheets if necessary.)
A
B
C
D
Name of certified QETC
EIN
Date of investment
Amount of investment
4 Amount of qualified investments
...........................................................
4
(add column D amounts)
5 Credit percentage (20%) .............................................................................................................
5
20
6 Credit for qualified investments to be held nine years
...
6
(multiply line 4 by line 5; see instructions)
Schedule B – Limitations of QETC capital tax credit
Fifty percent limitation
Part 1
7 Tax from Form CT‑3, CT‑3‑A, IT‑201, IT‑203, or IT‑205
...................................
7
(see instructions)
8 Multiply line 7 by 50% (.5) .........................................................................................................
8
Part 2
$150,000/$300,000 limitation
A – Qualified investments
B – Qualified investments
to be held at least 4 years
to be held at least 9 years
9 Limitation per section 210.12‑F ..................................
9
150,000 00
9
300,000 00
10 Limitations per section 606(r)
..........
10
10
(see instructions)
11 QETC capital tax credit previously allowed, less
any previous recapture .........................................
11
11
12 QETC capital tax credit still allowable
(subtract
......................................
12
12
line 11 from line 9 or line 10)
13 QETC capital tax credit allowable this year
......................................................
13
13
(see instructions)
14 Total QETC capital tax credit available this year
...........................
14
(add line 13, columns A and B)
467001120094
622001120094

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