Form Ct-60-Qsss - Affiliated Entity Information Schedule - 2013 Page 2
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2Page 2 of 2 CT-60-QSSS (2014)
Part 3 – Entities taxable as partnerships
(see instructions)
Name and address of partnership
EIN
Part 4 – Disregarded entities
(see instructions)
Name and address of disregarded entity
EIN
Certification: I certify that this document and any attachments are to the best of my knowledge and belief true, correct, and complete.
Printed name of authorized person
Signature of authorized person
Official title
Authorized
E-mail address of authorized person
Telephone number
Date
person
(
)
Firm’s name
Firm’s EIN
Preparer’s PTIN or SSN
(or yours if self-employed)
Paid
preparer
Signature of individual preparing this document
Address
City
State
ZIP code
use
only
E-mail address of individual preparing this document
Preparer’s NYTPRIN
Date
(see instr.)
478002140094
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