Form St-141 - Individual Purchaser'S Periodic Report Of Sales And Use Tax (Page 3 of 3) in pdf

ST-141 (12/12) Page 3 of 3

Purchase price

Your sales and

Tax

Tax paid to another

Tax due

use tax rate

taxing jurisdiction, if any

(see instructions)

(multiply column A

(subtract column D from column C;

(from Charts 2 or 3;

by column B)

(see instructions)

do not enter less than zero)

see instructions)

1 Total

..............................................

(add the Part I, column E amounts; do not enter less than zero)

Part 2 — All other taxable items and services

List all other taxable items and services on which no New York State or local tax was collected from you at the time of purchase, or on which

you owe additional local tax (see instructions). Shipping and handling charges must be included in column A when computing your tax due.

Attach additional sheets if necessary. If any item or service purchased cost $25,000 or more each, excluding shipping and handling, you must

also complete Form IT-135, Sales and Use Tax Report for Purchases of Items and Services Costing $25,000 or More, and attach it to this form.

Note: Any unpaid sales or use tax on a motor vehicle, trailer, all-terrain vehicle, vessel, or snowmobile that must be registered or titled by the

New York State Department of Motor Vehicles is collected at the time of registration. Therefore, do not report or pay the sales or use tax on

these items on this form.

Purchase price

Combined

Tax

Tax paid to another

Tax due

state and local rate

taxing jurisdiction, if any

(see instructions)

(multiply column A

(subtract column D from column C;

(from Chart I;

by column B)

(see instructions)

do not enter less than zero)

see instructions)

2 Total

..................................................

(add the Part 2, column E amounts; do not enter less than zero)

3 Add lines 1 and 2; transfer this amount to the Computation of total sales or use tax due

section, line 3 on page 1 of this form ..............................................................................................

I certify that the above statements are true and correct, and I make these statements with the knowledge that willfully issuing a false or

fraudulent document with the intent to evade tax may constitute a felony under New York State Tax Law, punishable by a substantial fine and

a possible jail sentence. I also understand that the Tax Department is authorized to investigate the validity or the accuracy of any information

entered on this document.

Purchaser’s signature

Date

Telephone number for purchaser

(

)

Printed name of preparer

Preparer’s PTIN

(if other than purchaser)

Preparer’s address

Preparer’s NYTPRIN

Preparer’s signature

Preparer’s telephone number

(if other than purchaser)

(

)

Need help?

Private delivery services

If you choose, you may use a private delivery service, instead of

Visit our Web site at

the U.S. Postal Service, to mail in your return and tax payment.

• get information and manage your taxes online

However, if, at a later date, you need to establish the date you filed

• check for new online services and features

your return or paid your tax, you cannot use the date recorded

by a private delivery service unless you used a delivery service

Sales Tax Information Center:

(518) 485-2889

that has been designated by the U.S. Secretary of the Treasury or

the Commissioner of Taxation and Finance. (Currently designated

To order forms and publications:

(518) 457-5431

delivery services are listed in Publication 55, Designated Private

Delivery Services. See Need help? above for information on

Text Telephone (TTY) Hotline

obtaining forms and publications.) If you have used a designated

(for persons with hearing and

private delivery service and need to establish the date you filed your

speech disabilities using a TTY):

(518) 485-5082

return, contact that private delivery service for instructions on how to

obtain written proof of the date your return was given to the delivery

service for delivery.

Form St-141 - Individual Purchaser'S Periodic Report Of Sales And Use Tax Page 3

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