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$100.. 200.

No. 24.

Organization Tax Table, Showing One-eighth of One Per Cent. on

Various Amounts.

(Tax Law, § 180.)

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No. 25.

Affidavit for Exemption from the Payment of Corporation Tax.

(Tax Law, § 183.)

NOTE. In the space left for explanation of goods manufactured, give all the details, so that a perfect understanding of the business may be obtained by the comptroller.

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Affidavit, for exemption from the payment of corporation tax, as levied under section 182 of the Tax Law.

STATE OF NEW YORK,

COUNTY OF....

18..,

...

Personally appeared before me, this ...... day of who, being duly sworn, deposes and says that he is the ... .... of the company; that the abovenamed company was organized on the .... day of ..... 18.., under chapter .., Laws of 18.., for the purpose of engaging in, and that it is engaged in, the manufacture of

.......

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[L. S.]

88.:

....

that the business of said company is exclusively manufacturing within the State of New York, and the sale of products so manufactured (or that such corporation is engaged in manufacturing within the State of New York, and in the sale of products so manufactured to the extent of dollars of its capital employed within the State, and that the remainder of such capital, amounting to dollars, is employed in the business of

at No.

street, in the city of

.....). Subscribed and sworn to before me,

this..... day of

18.. ""

No. 26.

Report of Dividends.

(Tax Law, §§ 182, 189, subd. 1.)

....

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......

Notary Public.

[Notary public or other officer should always use a seal.]

Date of organization of the company
Total authorized capital of company

[Blanks may be procured on application to comptroller.] Report of the ... Company, for the year ending the 1st day of November, A. D. 18.., made pursuant to the provisions of section 189 of the Tax Law.

[Give post-office address of company, street and number.]

18..

To the Comptroller of the State of New York:

Agreeably to law, as treasurer of the above company, I make the

following report, viz.:

Whole number of shares of stock authorized..

Number of shares of stock issued

Par value of each share

Amount paid into the treasury of the company on each

share ..

......

Amount of capital paid in..

Amount of capital upon which dividends were declared... $.

Date of each dividend declared

Amount of each dividend declared...

STATE OF NEW YORK,

COUNTY OF.

Rate per cent. per annum of dividends...

Capital stock employed in New York State..

$.

[Preceding line need not be filled out by companies whose capital is all employed in this State.]

If not New York State, where and how employed.....

......

88.:

.....

$.

On this day of A. D., 18. ., personally appeared before me, a notary public in and for the county of treasurer of the above-named company, who, being duly sworn according to law, did depose and say that the foregoing report is just and true, according as the accounts stand in the books of the company, and that it includes all dividends, whether cash, stock, scrip, or of any other character or description, declared by said company during the year ending on the 1st day of November, A. D., 18..

Subscribed and sworn to before me, the day and year aforesaid.

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Treasurer.

......

[L. S.]

Notary Public.

[Notary public, or other officer, should always use a seal.]

....

Treasurer.

No. 27.

Report of Dividends and Appraisement.

(Tax Law, §§ 182, 189.)

[Report and appraisement for the year in which no dividend has been declared, as shown by the first page of this report.]

Company, for the

Report and appraisement of the year ending the 1st day of November, 18..

STATE OF NEW YORK,
COUNTY OF...

......

On this

day of

...

per

A. D. 18.., before me, the subscriber, a notary public in and for the county of sonally appeared treasurer, and secretary of the above-named company, who, being by me severally duly sworn, did say that the amount of capital stock paid in of said company is $..... ..., and that said company declared no dividend in cash, stock, scrip, or of any other character or description during the year ending the 1st day of November, 18.., save the dividends herein reported, and that they will, with fidelity, according to the best of their knowledge and belief, estimate and appraise the capital stock of said company at its actual value in cash, not less, however, than the average price which said stock is sold for during said year.

.....

Office of the

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Subscribed and sworn to before me,

the day and year aforesaid.

[Blanks may Report of gross

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....

Notary Public.
Company,

....

....

18..

We, the undersigned, being the treasurer and secretary of the abovenamed company, do certify that, in pursuance of our aforesaid oaths, we have estimated and appraised the capital stock of said company, at its actual value in cash, as follows, viz.: shares, at cents per share, amounting

dollars and

No. 28.

Report of Gross Earnings.

(Tax Law, §§ 184, 189, subd. 2.)

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......

Treasurer.

....

Secretary.

in the whole, to

dollars.

In witness whereof, we have hereunto set our hands the day and year aforesaid.

Treasurer.

Secretary.

be procured on application to comptroller.] earnings, in the State of New York, of the .... Company, for the year ending June 30, 18.., made in accordance with the requirements of section 189 of the Tax Law.

Office of the

... Company,

[Give post-office address, with number and street.]

Gross earnings derived from all sources during the above period. ...

For tolls and transportation

For telegraph business

For express business
Taxable gross receipts

} 88

.....

88.:

STATE OF NEW YORK,

COUNTY OF...

.....

.....

On this ...... day of A. D. 18.., personally appeared before me, a notary public in and for the county of treasurer of the ... Company, who, being duly sworn according to law, did depose and say that the foregoing report is true and correct.

Sworn to and subscribed before me, the day and year aforesaid.

[L. S.]

Notary Public.

$.

$

.....

$.

.....

18..

No. 29.

Report of Gross Premiums.

(Tax Law, §§ 187, 189, subd. 5.)

[Blanks may be procured on application to comptroller.] Report of gross premiums of the Insurance Company, for the year ending June 30, 18.., made in accordance with the requirements of section 189 of the Tax Law.

Office of the

Insurance Company,

[Give post-office address, with number and street.]

Treasurer.

18..

The premiums received during the above-named period, whether received in money or in the form of notes, credits, or any other substitute for money, amount to $....

Secretary.

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