Form Dtf-17 - Application For Registration As A Sales Tax Vendor - New York Page 2
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2Page 2 of 2 DTF-17 (6/06)
24 Have you been notified that you owe any New York State tax? .................................................................................................................... Yes
No
Type of tax
Amount due
Assessment number (if any)
Assessment date
Assessment currently being
protested? .......... Yes
No
25 Do any responsible officers, directors, partners, members, managers, or employees owe New York State or local sales and use taxes on
your behalf, on behalf of another person, as a vendor of property or services, as operator of a hotel, or as recipient of amusement charges? ..
Yes
No
Individual’s name
Street address
City
State
ZIP code
Social security number
Amount due
Assessment number (if any)
Assessment date
Assessment currently being
protested? .......... Yes
No
26 Have you been convicted of a crime under the Tax Law during the past year? ........................................................................................... Yes
No
Date of conviction
Court of conviction
Disposition (fine, imprisonment, probation, etc.)
27 During the past year, has any responsible officer, director, partner, member, manager, or employee of the applicant been convicted of
a crime under the Tax Law? ......................................................................................................................................................................
Yes
No
Individual’s name
Street address
City
State
ZIP code
Social security number
Date of conviction
Court of conviction
Disposition (fine, imprisonment, probation, etc.)
28 If previously registered as a New York State sales tax vendor, was your Certificate of Authority revoked or suspended
during that past year?
No
Yes
If Yes, please indicate why
Questions 29, 30, and 31 apply to corporations only. If not a corporation, proceed to line 32.
29 If any shareholder owns more than half of the shares of voting stock of the applicant, has this shareholder ever owned
more than half of the shares of voting stock of another corporation?
No
Yes
If Yes, complete questions 30 and 31.
...............
30 Did this shareholder own these shares of another corporation when the corporation had a tax liability that remains unpaid?
Yes
No
Shareholder’s name and SSN
Corporation name
Corporation’s federal identification number
Street address
City
State
ZIP code
Type of tax
Amount due
Assessment number (if any)
Assessment date
Assessment currently being
protested? .......... Yes
No
31 Did this shareholder own these shares of another corporation at a time during the past year when the corporation was
convicted of a crime under the Tax Law? .................................................................................................................................................
Yes
No
Corporation name
Federal identification number
Street address
City
State
ZIP code
Date of conviction
Court of conviction
Disposition (fine, imprisonment, probation, etc.)
32 If you acquired this business from a registered vendor, did you file Form AU-196.10, Notification of Sale, Transfer or Assignment in Bulk, with the Tax Department? Yes
No
Former owner’s name
Address
ID #
I certify that the information in this application is true and correct. Willfully filing a false application is a misdemeanor punishable under the Tax Law.
(see instructions)
Signature
Title
Telephone number
Date
Check this box if you want your sales tax returns mailed to a tax preparer rather than the address on the front of this application. Enter
preparer information in the box below:
Name of preparer
Street Address
City
State
ZIP code
This application will be returned if it is not signed or if any other information is missing.
Mail your application to: NYS Tax Department, Sales Tax Registration Unit, W A Harriman Campus, Albany NY 12227, at least 20 days (but not more than 90
days) before you begin doing business in New York State.
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