Claim for New York City School Tax Credit - New York

210001140094
Your signature
Your occupation
Spouse’s signature and occupation (if joint claim)
Date Daytime phone number
E-mail:
New York State Department of Taxation and Finance
Claim for New York City School Tax Credit
Type of claim –
mark an X in one box
(see instructions)
NYC-210
1 Can you be claimed as a dependent on another taxpayers 2014 federal return? ............................. 1 Yes No
If you marked an X in box a, c, or d above, and marked the Yes box at line 1, stop;
youdonotqualifyforthecredit.Allotherlerscontinuewithline2.
2 Enter, in the box to the right, the number of months during 2014 that you lived in
New York City
(see Note above; also see instructions) ............................................................................... 2 months
If you marked an Xinboxbabove,continuewithline3.Allotherlerscontinuewithline5.
3 Can your spouse be claimed as a dependent on another taxpayers 2014 federal return? .............. 3 Yes No
If you marked an X in the Yes box at both lines 1 and 3, stop; you do not qualify for this
credit.Allotherlerscontinuewithline4.
4 Enter, in the box to the right, the number of months during 2014 your spouse lived in
New York City
(see Note above; also see instructions) ....................................................................... 4 months
Marriedbutlingaseparate claim
c
(complete lines 1, 2, and 5)
Qualifying widow(er) with dependent
d
child (complete lines 1, 2, and 5)
Note: Usethisformonlyifyouarenotrequiredtolea2014FormIT-201orIT-203, and you lived in New York City for any part of
2014. You lived in New York City if you lived in any of the following counties during 2014: Kings County (Brooklyn), Bronx, New
York County (Manhattan), Richmond County (Staten Island), or Queens. If you did not live in any of these counties for all or part of
the year, stop; you do not qualify for this credit.
Single
a
(complete lines 1, 2, and 5)
Marriedlingacombined claim
b
(complete lines 1 through 5)
You must enter your date(s) of
birth and social security number(s)
above.
5 Mark one refund choice (see instructions): direct deposit (ll in line 6) - or - debit card - or - paper check
Printdesignee’sname Designee’sphonenumber Personalidentication
( )
number (PIN)
E-mail:
Third-party
designee?
(see instr.)
Yes No
Address of New York City residence that qualies you for this credit, if different from above
City State ZIP code
NY
Your rstname MI
Your last name (for a combined claim, enter spouse’s name on line below)
Your date of birth (mmddyyyy) Your social security number
Spouse’srstname MI Spouse’s last name
Spouse’s date of birth (mmddyyyy) Spouse’s social security number
Mailing address
(number and street or PO box) Apartment number
City,village,orpostofce State ZIPcode Country
(if not United States)
NYS county of residence while living in NY City
6 Direct deposit (see instructions): Complete the following to have your refund deposited directly to your bank account.
6a Routing 6b
Account
Personal Personal Business Business
number type: checking
- or -
savings
- or -
checking
- or -
savings
Note: If the funds for your refund would go to an account 6c
Account
outside the U.S., mark an X in this box (see instructions) ... number
Taxpayer(s) must sign here
( )
Paid preparer must complete (see instr.)
Date
Preparers signature Preparers NYTPRIN
Firm’s name (or yours, if self-employed) Preparers
PTIN or SSN
Address
Employeridenticationnumber
NYTPRIN
excl. code
E-mail:
Taxpayers date of death (mmddyyyy) Spouse’s date of death (mmddyyyy)
Decedent
information
For office use only
Page 1/2
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