Child Tax Credits Form - New York
213001140094
1
Were you (and your spouse if ling a joint New York State return) New York State residents for all of 2014?
1 Yes No
If you marked an X in the No box, stop; you do not qualify for this credit.
2 Did you claim the federal child tax credit or additional child tax credit for 2014? ....................................... 2 Yes No
3 Is your federal adjusted gross income
(see instructions)
– $110,000 or less and your ling status is married ling joint return;
–
$75,000 or less and your ling status is single, head of household, or qualifying widow(er); or
– $55,000 or less and your ling status is married ling separate return? .......................................... 3 Yes No
If you marked an X in the No box at both lines 2 and 3, stop; you do not qualify for this credit.
4 Enter the number of children who qualify for the federal child tax credit or
additional child tax credit
(see instructions) ............................................................................................... 4
5
Enter the number of children from line 4 that were at least four but less than 17 years of age on December 31, 2014
.. 5
If you entered 0 on line 5, stop; you do not qualify for this credit.
New York State Department of Taxation and Finance
Claim for Empire State Child Credit
IT-213
First name MI
Social security number
Date of birth
(mmddyyyy)
Step 3 – Enter child information
List below the name, social security number, and date of birth for each child included on line 4.
Last name
Submit this form with Form IT-201 or IT-203.
Step 1 – Enter identifying information
Your name as shown on return Your social security number
Spouse’s name Spouse’s social security number
Use Form IT-213-ATT if you have additional children to report (see instructions).
Step 2 – Determine eligibility
Page 1/2
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Child Tax Credits Form - New York PDF
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