Form Nys-1-Mn Retun Of Tax Withheld Nys Page 2

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Scroll down to complete the back of Form NYS-1-MN
Cut on dotted lines before filing this form.
NYS-1-MN (1/10) (back)
Paid preparer: If you are using a paid preparer or payroll service, have the preparer or payroll service complete the appropriate section(s) below.
Preparer’s signature
Telephone number
Date
Mark an
Preparer’s SSN or PTIN
X if
(
)
self-employed
Preparer’s firm name
Address
Preparer’s EIN
(or preparer’s name, if self-employed)
Payroll service’s name
Payroll service’s EIN
Make check payable to NYS Income Tax and mail to:
Taxpayer’s business name
NYS TAX DEPARTMENT, PROCESSING UNIT
PO BOX 4111, BINGHAMTON NY 13902-4111
c/o
attn
( if applicable, mark either box and enter name )
If you are a PrompTax participant and you are filing a paper return,
Number and street or PO box
mail your return and payment to:
PROMPTAX, NYS TAX DEPARTMENT,
City
State
ZIP code
PO BOX 4131, BINGHAMTON NY 13902-4131
New employer or address change: Enter at right the
If the address above is for your paid preparer, mark an X in the c/o box,
address at which you will receive withholding tax forms
enter the preparer’s name on the second line, and mark an X in this box ..
and notices. For other changes, see instructions.

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