Free Form CT-189-WR - New York

CT-189-WR Claim for Refund of Section 189 (8/00)
Tax and Tax Surcharges
Tax Law -- Article 9, Section 189
Employer identification number Social security number

New York State Department of Taxation and Finance

For office use only

Name

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State ZIP code

NG
Date received

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(
Type of organization:

)

Audit use

Corporation

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Individual

Other:

Period
Enter period covered by this refund claim. From: to

Schedule A -- Refund of tax based on price differential
Part I -- Refund of tax and tax surcharge collected by a regulated public utility (sections 189 and 189-b)
Line A -- Number of Mcf's (1,000 cubic feet) of gas service imported by and delivered to you in New York State during the period covered by this claim: 1 Section 189 tax and 189-b tax surcharge paid per utility bill ....................................................................... 2 Actual consideration paid for same period ................................................ 2 3 Tax rate (see instructions) ............................................................................ 3 4 Tax due under section 189 (multiply line 2 by line 3) .................................... 4 5 Tax surcharge due under section 189-b (multiply line 4 by the applicable rate) 5 6 Total tax and tax surcharge due (add lines 4 and 5) ...................................................................................... 7 Refund (subtract line 6 from line 1) .................................................................................................................

Part II -- Refund of metropolitan transportation business tax (MTA surcharge) collected by a regulated public utility
(section 189-a) Line B -- Number of Mcf's (1,000 cubic feet) of gas service imported by and delivered to you in the Metropolitan Commuter Transportation District (MCTD) during the period covered by this claim: 8 Section 189-a MTA surcharge paid per utility bill ......................................................................................... 8 9 Actual consideration paid for same period ................................................ 9 10 Adjusted MTA surcharge rate (see instructions) .......................................... 10 11 MTA surcharge due under section 189-a (multiply line 9 by line 10) .............................................................. 11 12 Refund (subtract line 11 from line 8) ................................................................................................................ 12

Part III -- Total refund of sections 189, 189-a, and 189-b tax and tax surcharges
13 Total refund (add lines 7 and 12) .................................................................................................................... 13

Schedule B -- Refund of the full amount of section 189, 189-a, and 189-b tax and tax surcharges collected by a regulated public utility
14 Number of Mcf's (1,000 cubic feet) of gas service upon which tax was collected during the period covered by the refund claim ..................................................................................................................... 15 Section 189 tax and 189-b tax surcharge per utility bill (see instructions) ..................................................... 16 Number of Mcf's of gas service upon which the metropolitan transportation tax (MTA surcharge) was collected during the period covered by the refund ................................................................................... 17 Section 189-a MTA surcharge paid per utility bill (see instructions) .............................................................. 18 Refund of sections 189, 189-a, and 189-b tax and tax surcharges (add lines 15 and 17) ............................. 14 15 16 17 18

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CT-189-WR (8/00) (back)

Schedule C -- Refund of tax and tax surcharges to a co-generation facility that does not have a section 189 direct pay permit
Part I -- Refund of tax and tax surcharge collected by a regulated public utility based on price differential
(sections 189 and 189-b) Line A -- Number of Mcf's (1,000 cubic feet) of gas service imported by and delivered to you in New York State during the period covered by this claim: 19 Section 189 tax and 189-b tax surcharge paid per utility bill ....................................................................... 20 Actual consideration paid for same period ................................................ 20 21 Tax rate (see instructions) ............................................................................ 21 22 Tax due under section 189 (multiply line 20 by line 21) ................................ 22 23 Tax surcharge due under section 189-b (multiply line 22 by the applicable rate) 23 24 Total tax and tax surcharge due (add lines 22 and 23) .................................................................................. 25 Refund (subtract line 24 from line 19) ..............................................................................................................

Part II -- Refund of MTA surcharge based on price differential collected by a regulated public utility (section 189-a)
Line B -- Number of Mcf's (1,000 cubic feet) of gas service imported by and delivered to you in the MCTD during the period covered by this claim: 26 Section 189-a MTA surcharge paid per utility bill ......................................................................................... 27 Actual consideration paid for same period ................................................ 27 28 Adjusted MTA surcharge rate (see instructions) .......................................... 28 29 MTA surcharge due under section 189-a (multiply line 27 by line 28) ............................................................. 30 Refund (subtract line 29 from line 26) ..............................................................................................................

Part III -- Refund for co-generation facilities exemption (sections 189 and 189-b)
31 32 33 34 35 BTU value of electricity and steam supplied to thermal energy host ........................................................... BTU value of total electricity and steam produced by the co-generator ...................................................... Exemption percentage (divide line 31 by line 32; enter result to two decimal places) .......................................... Section 189 tax and 189-b tax surcharge paid for refund period (see instructions) ...................................... Refund (multiply line 34 by the percentage on line 33) ...................................................................................... 31 32 33 34 35

Part IV -- Refund for co-generation facilities exemption (MCTD) (section 189-a)
36 37 38 39 40 BTU value of electricity and steam supplied to thermal energy host in the MCTD ..................................... BTU value of total electricity and steam produced by the co-generator in the MCTD ................................. Exemption percentage (divide line 36 by line 37; enter result to two decimal places) .......................................... Section 189-a MTA surcharge paid for refund period (see instructions) ........................................................ Refund (multiply line 39 by the percentage on line 38) ...................................................................................... 36 37 38 39 40

Part V -- Total refund of section 189, 189-a, and 189-b tax and tax surcharge to co-generators
41 Total refund (add lines 25, 30, 35, and 40) ...................................................................................................... 41

Schedule D -- Refund of tax for any other reason (Attach your revised tax computation and a computation of your refund)
In accordance with Article 27, section 1087, of the Tax Law, I make the following claim for credit or refund of tax paid. Tax period ending ................................................ Amount of claim .................................................. $ Reason for claim .................................................

Certification. I certify that this return and any attachments are to the best of my knowledge and belief true, correct, and complete.
Signature of elected officer or authorized person Official title Date

Paid preparer use only

Firm's name (or yours if self-employed)

ID number

Address

Signature of individual preparing this return

Mail this return to: NYS TAX DEPARTMENT, TTTB -- FACCTS, BUILDING 8, W A HARRIMAN CAMPUS, ALBANY NY 12227

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