Form Ct-613 - Claim For Environmental Remediation Insurance Credit - 2012 Page 2
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2Page 2 of 2 CT-613 (2012)
Partnership information
(see instructions for line 4)
Name of partnership
Partnership’s EIN
Amount of credit
Total from attached sheet(s) if any ....................................................................................................................
17 Total credit amount allocated from partnership(s)
........................................... 17
(enter here and on line 4)
521002120094
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