Form Ct-613 - Claim For Environmental Remediation Insurance Credit - 2012
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1
2New York State Department of Taxation and Finance
CT-613
Claim for Environmental Remediation
Insurance Credit
Tax Law – Article 1, Section 23; Article 9, Section 187; Article 9-A, Section 210.35;
Article 32, Section 1456(s); and Article 33, Section 1511(w)
All filers must enter tax period:
beginning
ending
Legal name of corporation filing franchise tax return
Employer identification number (EIN)
File this form with your franchise tax return.
Enter the date of execution of the Brownfield Cleanup Agreement (BCA) for the property for
which you are claiming this credit ....................................................................................................
A Mark an X in the box if you are claiming this credit as a corporate partner
....................................
A
(see instructions)
Brownfield site identifying information
Enter the following information as listed on the Certificate of Completion (COC) issued by the Department of
Environmental Conservation (DEC) for the qualified site (see instructions). Attach a copy of the COC. Also attach a copy
of the certification form for the environmental remediation insurance tax credit completed by the insurer.
Site name
Site location – municipality
Site location – county
DEC region
Division of Environmental Remediation (DER) site number
Date COC was issued
Mark an X in the box if you received notification from the Department of State that the qualified site
is located in a Brownfield Opportunity Area ...................................................................................................................
Computation of available environmental remediation insurance credit
1 Qualified environmental remediation insurance premiums paid ........................................................
1
2 Multiply line 1 by 50% (.5) ....................................................................................................................
2
3 Enter line 2 amount or 30,000, whichever is less .................................................................................
3
4 Environmental remediation insurance credit received from a flow-through entity
.....
4
(see instructions)
5 Subtotal
.......................................................
5
(add lines 3 and 4; New York S corporations, see instructions)
6 Recapture of credit
....................................................................................................
6
(see instructions)
7 Total environmental remediation insurance credit available for use
..........................
7
(see instructions)
Computation of environmental remediation insurance credit limitation
8 Tax due before credits
8
................................................................................................
(see instructions)
9 Enter other credits claimed before the environmental remediation insurance credit
......
9
(see instructions)
10 Net tax
.......................................................................................................... 10
(subtract line 9 from line 8)
11 Minimum tax
............................................................................................................... 11
(see instructions)
12 Credit limitation
...............................
12
(subtract line 11 from line 10; if line 11 is greater than line 10, enter 0)
Computation of environmental remediation insurance credit used, refunded, or credited as an overpayment in the
next tax year
13 Environmental remediation insurance credit to be used for the current tax year
.....
13
(see instructions)
14 Environmental remediation insurance credit available for refund or as an overpayment
(subtract
..............................................................................................................................
14
line 13 from line 7)
15 Environmental remediation insurance credit to be refunded
...
15
(limited to the amount on line 14; see instructions )
16 Environmental remediation insurance credit to be credited as an overpayment in the next tax year
.......................................................................................
16
(subtract line 15 from line 14; see instructions)
521001120094
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