Form NYC-210 (Fill-in) Claim for New York City School Tax Credit

(complete lines 1 2 and 5) (complete lines 1 2 and 5) (complete lines 1 through 5) child (complete lines 1 2 and 5) (see instructions) 1 Can you be claimed as a dependent on another taxpayer s 2011 federal return? 1 Yes 2 Enter in the box(es) to the right the number of months during 2011 that you lived in 2101110094 4 Enter in the box(es) to the right the number of months during 2011 your spouse lived in New York City (see Note above; also see instructions) 4 5 Mark one refund choice (see instructions): 6 Direct deposit (see instructions): Complete the following to have your refund deposited directly to your bank account Note: If the funds for your refund would 6a Routing number accommodations for persons with disabilities callTo order forms and publications: (518) 457 5431 the information center ax Cr axation and Finance Claim for New Y debit card or Off direct deposit (fill in line 6) or disabilities If you have questions about special Failure to provide the required information may subject you to civil or criminal penalties or both under the Tax Law File your claim as soon as you can after January 1 2012 Mail your claim to: go to an account outside the U S Off If you choose you may use a private delivery service instead of the U S Postal Service to mail in your form and tax payment However if at a later date you need to establish the date you filed or paid your tax you cannot use the date recorded by a private delivery service unless you used a delivery service that has been designated by the U S Secretary of the Treasury or the Commissioner of Taxation and Finance (Currently designated delivery services are listed in Publication 55 Designated Private Delivery Services See Need help? below for information on obtaining forms and publications ) If you have used a designated private delivery service and need to establish the date you filed your form contact that private delivery service for instructions on how to obtain written proof of the date your form was given to the delivery service for delivery If you use any private delivery service whether it is a designated service or not send the forms covered by these instructions to: State Processing Center 101 Enterprise Drive Kingston NY 12401 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 filers continue with line 2 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 filers continue with line 4 Information concerning quarterly wages paid to employees is provided to certain state agencies for purposes of fraud prevention support enforcement evaluation of the effectiveness of certain employment and training programs and other purposes authorized by law mark an X in one box mark an X in this box (see instructions) Married but filing a separate claim Married filing a combined claim Off months months If you marked an X in box b above continue with line 3 All other filers continue with line 5 3 Can your spouse be claimed as a dependent on another taxpayer s 2011 federal return? 3 Need help? New Y New York City (see Note above; also see instructions) 2 No OffOff Note: Use this form only if you are not required to file a 2011 Form IT 201 or IT 203 and you lived in New York City for any part of 2011 You lived in New York City if you lived in any of the following counties during 2011: 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 NYC 210 NYC 210 (2011) (back) OffOff ork City School T ork State Department of T other facilities are accessible to persons with out where machines are available for public use paper check Personal Income Tax Information Center: (518) 457 5181 Persons with disabilities: In compliance with the Americans with Disabilities Act we will ensure Automated income tax refund status: (518) 457 5149 Please file this original scannable credit form with the Tax Department Privacy notification Private delivery services Qualifying widow(er) with dependent Single STATE PROCESSING CENTER PO BOX 61000 ALBANY NY 12261 0001 Telephone assistance Text Telephone (TTY) Hotline (for persons with hearing and speech disabilities using a TTY): If you have access to a TTY contact us at (518) 485 5082 If you do not own a TTY check with independent living centers or community action programs to find that our lobbies offices meeting rooms and The Commissioner of Taxation and Finance may collect and maintain personal information pursuant to the New York State Tax Law including but not limited to sections 5 a 171 171 a 287 308 429 475 505 697 1096 1142 and 1415 of that Law; and may require disclosure of social security numbers pursuant to 42 USC 405(c)(2)(C)(i) This information is maintained by the Manager of Document Management NYS Tax Department W A Harriman Campus Albany NY 12227; telephone (518) 457 5181 This information will be used to determine and administer tax liabilities and when authorized by law for certain tax offset and exchange of tax information programs as well as for any other lawful purpose Type of claim a