Form Dtf-664 - Tax Shelter Disclosure For Material Advisors - 2011
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2DTF-664
New York State Department of Taxation and Finance
Tax Shelter Disclosure for
Material Advisors
Tax Law Section 25(b)(1)
Material advisor’s name
Employer identification number (EIN) or social security number
Mailing address of material advisor
( number and street or rural route )
City, village, town, or post office
State
ZIP code
Telephone number
(
)
Material advisor’s e-mail address
Aggregate material advisor’s fees
Attach a copy of the statement or return filed with the Internal Revenue Service (IRS) pursuant to section 6111 of the Internal
Revenue Code (IRC) (currently federal Form 8918, Material Advisor Disclosure Statement) . Also include all documentation submitted
to the IRS in connection with the statement or return and mail to the address shown below. For more information, see the instructions
on the back of this form.
Tax shelter information
Type of business organization
( mark an X in all that apply )
Partnership
( including a limited partnership )
Trust
S corporation
Federal Schedule C or Schedule F activity
Other
( specify )
Enter the tax shelter’s six-digit NAICS business code number
..............................................
( from the federal tax return )
Certification: I certify that this disclosure and any attachments are to the best of my knowledge and belief true, correct, and complete.
Signature
Official title
Date
Firm’s name
Firm’s EIN
Preparer’s PTIN or SSN
(or yours if self-employed)
Paid
preparer
Signature of individual preparing this disclosure
Address
City
State
ZIP code
use
only
E-mail address of individual preparing this disclosure
Preparer’s NYTPRIN
Date
(see instr.)
Mail Form DTF-664 and a copy of federal Form 8918 to:
Private delivery services — If you choose, you may use a
private delivery service, instead of the U.S. Postal Service, to
NYS DEPARTMENT OF TAXATION AND FINANCE
mail in your form and tax payment. However, if, at a later date,
TAX SHELTER DISCLOSURE
you need to establish the date you filed or paid your tax, you
PO BOX 22104
cannot use the date recorded by a private delivery service
ALBANY NY 12201-2104
unless you used a delivery service that has been designated
by the U.S. Secretary of the Treasury or the Commissioner of
If you are using a private delivery service, see Private delivery
Taxation and Finance. (Currently designated delivery services
services below for more information.
are listed in Publication 55, Designated Private Delivery
Services. See Need help? for information on obtaining forms
Need help?
and publications.) If you have used a designated private
delivery service and need to establish the date you filed your
form, contact that private delivery service for instructions on
Internet access:
how to obtain written proof of the date your form was given to
(for information, forms, and publications)
the delivery service for delivery. If you use any private delivery
service, whether it is a designated service or not, send the
Corporation Tax Information Center:
(518) 485-6027
forms covered by these instructions to: NYS Tax Department,
Personal Income Tax Information Center: (518) 457-5181
Tax Shelter Disclosure, W A Harriman Campus, Albany NY
12227.
6641110094
66401110094
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