Office of Processing and Taxpayer Services
              W A Harriman Campus
              Albany NY 12227

                                 Annualized Exception Worksheet for Form CT-222

Taxpayer’s name:                                                                Employer identification number (EIN):

Contact name:                                             Contact title:                   Telephone number:         (    )

Tax period ended:      /    /    Mark an  Xin the applicable box(es)     State: MTA surcharge:

                  A                                     B                       C                                          D
              Month of           Monthly allocated amount                       Monthly tax credits for              Monthly other taxes
              tax year                for the year of penalty*                  the year of penalty                  (e.g., subsidiary capital) for
              (mm/yy)                                                                                                the year of penalty
1 stmonth:
2 ndmonth:
3 rdmonth:
4 thmonth:
5 thmonth:
6 thmonth:
7 thmonth:
8 thmonth:
9 thmonth:
10 thmonth:
11 thmonth:
12 thmonth:

Signature of authorized person:                                          Telephone number: (      )                  Date:  /    /

TR-620 (7/11)

                                                                 Instructions

Line instructions
Column A — Enter the applicable month and year that corresponds with this line.
Column B — Enter the applicable monthly amount of receipts, income, and expenses that correspond to the highest tax base (before credits)* for the year of   
           penalty.
Column C — Enter the applicable monthly credit amount that corresponds with the tax credits applicable for that month.
Column D — Enter any other tax amounts that apply for that month.

* Highest tax base (before credits):
  • Entire net income (ENI)
  • Minimum taxable income (MTI)
  • Alternative ENI
  • Tax on premiums
  • Alternative tax
  • Gross earnings or gross income
  • Fixed dollar minimum tax (Article 9-A)

Fax your worksheet
Fax your completed worksheet to the Business Liability Resolution Center at (518) 435-8615. 

Need help?
If you have any questions or need further assistance, contact the Business Liability Resolution Center at (518) 485-0384.

TR-620 (7/11) (back)