Form Dtf-804 - Statement Of Transaction - Claim For Credit Of Sales Tax Paid To Another State, New York State

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DTF‑804
Department of Taxation and Finance
Statement of Transaction – Claim for
(5/15)
Credit of Sales Tax Paid to Another State
For Motor Vehicle, Trailer, All‑Terrain Vehicle (ATV),
Vessel (Boat), or Snowmobile
Use of this form is restricted to transactions processed by county clerk offices or the Department of Motor Vehicles and its agents.
Note: Misuse of this form may subject you to serious civil and criminal sanctions in addition to the payment of any tax and interest
due.
Type or print. Read instructions on page 2 before completing this form.
Owner
Purchased from
Last name, first name, middle initial (or business name)
SSN or EIN
Last name, first name, middle initial (or dealership name)
Number and street address
Number and street address
City
City
County
State
ZIP code
County
State
ZIP code
Vehicle type:
Motor vehicle (includes trailers)
All-terrain vehicle
Snowmobile
Boat/Trailer combination
Boat
:
ft.
(length in feet)
Year
Make
Model
Vehicle or hull identification number
Boats and boat/trailer combinations only – enter trailer information below
Year
Make
Model
Vehicle identification number
/
/
/
/
Date of purchase:
Purchase price: $
Date vehicle entered New York State:
yyyy
yyyy
mm
dd
mm
dd
Enter name of the other state where sales tax was paid
Refer to the chart on back to determine if you are eligible to claim a credit from the state to which you paid tax.
1
Amount subject to New York State tax
(for boats and boat/trailer combinations purchased or used on or after
...........................................................................
1
June 1, 2015, do not enter more than $230,000; see instructions)
2
Combined New York State and local tax rate
.........
2
%
(enter the tax rate imposed within your jurisdiction of residence)
3
New York State use tax due
..........................................................................................
3
(multiply line 1 by line 2)
4
4
Enter the tax rate paid to other state ......................................................................
%
5
Tax rate eligible for reciprocal credit
.........................................................................................
5
%
(see instructions)
6
Reciprocal credit
............................................................................................................
6
(multiply line 1 by line 5)
7
Net New York State use tax due
...........................
7
(subtract line 6 from line 3; this amount cannot be less than zero)
Certification: I certify that the above statements are true, complete, and correct, and that no material information has been omitted. I make these
statements and issue this exemption certificate with the knowledge that this document provides evidence that state and local sales or use taxes do
not apply to a transaction or transactions for which I tendered this document and that willfully issuing this document with the intent to evade any such
tax may constitute a felony or other crime under New York State law, punishable by a substantial fine and possible jail sentence. I understand that
this document is required to be filed with, and delivered to the recipient as agent for the Tax Department for the purposes of Tax Law section 1838,
and is deemed a document required to be filed with the Tax Department for the purpose of prosecution of offenses. I also understand that the Tax
Department is authorized to investigate the validity of tax exclusions or exemptions claimed and the accuracy of any information entered on this
document.
Signature of owner (sign in full)
Printed name of owner
Date
/
/
Privacy notification – See our Web site at or Publication 54, Privacy Notification.
For office use only
Taxable valuation
Tax rate
Tax due
Initials
Office
Date
/
/
Affidavit submitted
Proof of payment submitted
Possible audit

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