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A-5052-TC State of New Jersey
4-22 Estimated Summary Tax Return
(Important: See instructions before completing this form)

Period Beginning Ending
Proposed date of legal dissolution, withdrawal, merger, etc.
Federal Employer I.D. Number N.J. Corporation Number State and Date of Incorporation

Corporation Name Date authorized to do business in New Jersey

Date first began business in New Jersey

Mailing Address Date first acquired real property in New Jersey

City State ZIP Code Nature of business

Summary of New Jersey State Taxes
(Submit separate checks for each tax)

1. Amount of Estimated Liability for Corporation Business Tax .......................................................... $
(Complete Schedule I)
2. Amount of Estimated Liability for Sales and/or Use Taxes ............................................................. $
(Complete Schedule II)
3. Amount of Estimated Liability for Gross Income Tax (W/H) ............................................................ $
(Complete Schedule III)
4. Amount of Estimated Liability for All Other Taxes ........................................................................... $
(Complete Schedule IV)
5. Total Amount of Estimated Liability for All Taxes ............................................................................ $

Signature and Affirmation of an Officer of the Corporation
I declare and affirm, under the penalties provided by law, that this return (including any accompanying schedules and statements) has been
examined by me and to the best of my knowledge and belief is a true ESTIMATE of tax liability under Title 54 of the revised Statutes.

(Date) (Signature of Duly Authorized Officer of Taxpayer) (Title)

(Date) (Signature of Individual Preparing Return) (Address) (Preparer’s ID Number)

(Name of Tax Preparer’s Employer) (Address) (Employer’s ID Number)

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A-5052-TC
4-22
Schedule I
Computation of Estimated Corporation Business Tax

1. (a) Adjusted Entire Net Income ................................................................................................................ $

(b) Business Allocation Factor (if less than 100% allocated to New Jersey) ........................................... %
(c) Tax Base – Non-allocating taxpayers, enter amount from line 1(a). Allocating taxpayers,
multiply line 1(a) by line 1(b) and enter the result............................................................................... $
(d) Estimated Corporation Business Tax – Multiply line 1(c) by .09 or, if applicable, by .075 or .065.
(See instruction 5(a)). See instruction 5(b) for minimum tax requirements. New Jersey
S corporations must follow the instructions in 5(d) to calculate the appropriate estimated
Corporation Business Tax liability to be reported on this line ............................................................. $
( )e Alternative Minimum Assessment for C corporations. (See instruction 5(c) and the
CBT-100 instructions). Check here and enter zero if AMA is paid by Key Corporation ................. $
(f ) Total Estimated Corporation Business Tax Liability: Enter greater of 1(d) or 1(e)
Also enter on page 1, line 1. ............................................................................................................... $
Schedule II
Computation of Estimated New Jersey Sales and Use Tax
Enter tax paid over the last four reporting (quarterly) periods:
Period Ending Amount Paid

....................................................................................... $

Enter Estimated Tax for current or subsequent period (as applicable). Also enter on page 1, line 2. $
(Attach rider for method of computation of estimated tax, if applicable)
Schedule III
Computation of Estimated New Jersey Gross Income Tax Employer Withholdings
Enter tax paid over the last reporting periods:
Period Ending Amount Paid

....................................................................................... $

Enter Estimated Tax for current or subsequent period (as applicable). Also enter on page 1, line 3. $
(Attach rider for method of computation of estimated tax, if applicable)
Schedule IV
Computation of All Other New Jersey Taxes and Fees
Name of Tax/Fee Amount Due

Professional Corporation Fee ............................................................................................................ $

Other Taxes/Fees (UI/DI, etc.) ............................................................................................................ $

Total Estimated Fees and Other Taxes. Also enter on page 1, line 4. ............................................... $
(Attach rider for method of computation of estimated tax, if applicable)

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A-5052-TC
4-22
                            Instructions for Completing Form A-5052
 1. This form must be filed with the Application for Tax Clearance Certificate (Form A-5088-TC) whenever the taxpayer is unable to
    file a tax return for the final tax period. This form is not required if the application is submitted with an Assumption of Tax Liability
    for all taxes due. (See Form A-5033-TC, Step 1). An estimated Corporation Business Tax (CBT) liability is not required if the
    taxpayer is included as a member on a combined CBT return.
 2. This form must be completed before a Tax Clearance Certificate may be issued. It is to be completed on an estimated basis, for
    the current period from the close of the last accounting period for which a return is required to be filed with the Division to the
    proposed date of dissolution, merger, withdrawal, etc.
 3. There must be annexed to the Estimated Summary Tax Return an affidavit of a corporate officer covering the following items:
    (a) Computation of taxpayer’s actual entire net income from the close of its last accounting period for which a return is required
         to be filed with the Division to the latest practicable date.
    (b) Explanation of taxpayer’s method of computing estimated entire net income between such latest practicable date and the
         proposed date of filing such Certificate with the Division of Revenue, Business Liquidations.
    (c) A statement indicating whether taxpayer has realized or anticipates a gain on the sale, transfer, exchange, or conversion
         of any capital or other assets, other than normal sales of inventories, for the period covered by this return. The actual or
         estimated amount of such gains and the extent to which such gains have been included by the taxpayer in estimating its
         net income for the period covered by this return must be indicated.
 4. Upon receipt of this form and the Application for Tax Clearance Certificate, the taxpayer will be advised of any additional data
    required and of the amount of any additional payment that must be submitted before the Tax Clearance Certificate can be
    issued. Upon completion of our audit, after receipt of final return, any tax found to have been overpaid will be refunded.
 5. Computation of Estimated Corporation Business Tax
    (a) The tax rate is 9.0% (.09) on adjusted entire net income or such portion thereof as may be allocable to New Jersey. For
         taxpayers with entire net income of $100,000 or less, the tax rate is 7.5% (.075). For accounting periods beginning on or
         after January 1, 2002, if entire net income is $50,000 or less, the tax rate is 6.5% (.065).
    (b) Minimum Tax:
         (1) For the tax periods beginning on or after January 1, 2002, the minimum tax is $500, provided however that for a
         taxpayer that is a member of an affiliated or controlled group (as per section 1504 or 1563 of the Internal Revenue
         Code of 1986) that has a total payroll of $5,000,000 or more for the return period, the minimum tax shall be $2,000. Tax
         periods of less than 12 months are subject to the higher minimum tax if the prorated total payroll exceeds $416,667 per
         month. The minimum tax cannot be prorated.
         (2) For the tax periods beginning on or after January 1, 2006, the minimum tax is based on New Jersey Gross Receipts as
         follows (except for corporations that are members of affiliated groups with total payroll of $5,000,000 or more, whose
         minimum tax is $2,000 annually – see 5(b)(1) above).

         New Jersey Gross Receipts                        Minimum Tax for period begin:
                                                                                CBT-100S
                                                          CBT-100/BFC-1         On or after 
                                                                                01/1/2012
         Less than $100,000                                           $500      $375
         $100,000 or more but less than $250,000                      $750      $562
         $250,000 or more but less than $500,000          $1,000                $750
         $500,000 or more but less than $1,000,000        $1,500                $1,125
         $1,000,000 or more                               $2,000                $1,500

    (c) If the taxpayer is subject to the Alternative Minimum Assessment, see the instructions included in the Corporation
         Business Tax return (CBT-100) to compute the AMA. CBT return and instructions are available on the Division’s website at
         www.nj.gov/treasury/taxation/.
         The maximum AMA for a taxpayer is $5,000,000 for a privilege period. The AMA threshold limit is $20,000,000 for an
         affiliated group of five or more members.

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(d) Tax Rates for New Jersey S Corporations:
    (1) For a taxpayer that has entire net income in excess of $100,000 for the privilege periods ending on or after July 1, 
        2001, but on or before June 30, 2006, the tax rate shall be 1.33% and for the privilege periods ending on or after
        July 1, 2006, but on or before June 30, 2007, the tax rate shall be 0.67%; and
    (2) For a taxpayer that has entire net income of $100,000 or less for the privilege periods ending on or after July 1, 2001, 
        there shall be no rate of tax imposed. However, minimum tax shall apply. See 5(b) above.
    (3) The tax rate is 9% (.09) of entire net income that is subject to federal income taxation or such portion thereof as may be 
        allocable to New Jersey. For a taxpayer that has entire income of $100,000 or less, the tax rate is 7.5% (.075) and if 
        the entire income is $50,000 or less, the tax rate is 6.5% (.065).
    (4) The tax rate on the net pro rata share of the S corporation income allocated to New Jersey for the nonconsenting 
        shareholders is 10.75%. 
 6. Signature
Taxpayers who fail to sign the return shall have their applications rejected and returned causing delay in issuing tax clearance
certificates and eventual dissolution, withdrawal or merger proceedings. Tax preparers who fail to sign the return or provide their
assigned tax identification number will be liable for $25.00 penalty for each such failure.

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