Form St-75 - Sales And Use Tax Returns E-File Program - Enrollment Form And Certifications Page 4
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4Page 4 of 4 ST-75 (7/01)
paid preparer certification (required for all taxpayers using the services of a paid
Acknowledgment or witnessing of the
preparer)
This Paid preparer certification must be acknowledged before a notary public or witnessed by two disinterested individuals.
The person signing on page 3 as the paid preparer appeared before us and executed this Paid preparer certification.
Name of first witness
Date
Name of second witness
Date
(please type or print)
(please type or print)
Signature of first witness
Signature of second witness
Mailing address of first witness
Mailing address of second witness
(please type or print)
(please type or print)
Acknowledgment — individual
Acknowledgment — corporate
State of
ss:
State of
ss:
County of
County of
On this
day of
,
,
On this
day of
,
,
before me personally came,
before me personally came,
to me known, who, being by me duly sworn, did say that he/she
to me known to be the person(s) described in the foregoing Paid
resides at
(insert address)
;
preparer certification; and he/she/they acknowledged that he/she/they
that he/she is the
of
executed the same.
, the corporation described in the foregoing
Paid preparer certification; and that he/she/they signed his/her/their
name(s) thereto by authority of the board of directors of said
corporation, and that he/she/they knows the seal of said corporation;
that the seal affixed to such Paid preparer certification is such
corporate seal; that it was so affixed by order of the board of directors.
Signature of notary public
Date
Signature of notary public
Date
Notary public: affix stamp (or other indication of notary’s authority).
Notary public: affix stamp (or other indication of notary’s authority).
Acknowledgment — limited liability company
Acknowledgment — partnership/LLP
State of
ss:
State of
ss:
County of
County of
On this
day of
,
,
On this
day of
,
,
before me personally came,
before me personally came,
to me known, who, being by me duly sworn, did say that he/she/they/it
to me known, who, being by me duly sworn, did say that
reside(s) at
he/she/they/it reside(s) at
(insert address)
;
(insert address)
;
that he/she/they is (are) a member(s) or manager(s) of
,
that he/she/they is (are) a partner(s) of
,
the limited liability company described in the foregoing Paid preparer
the partnership described in the foregoing Paid preparer certification;
certification; and that he/she/they is (are) empowered to and did execute
and that he/she/they is (are) empowered to and did execute the
the same.
same.
Signature of notary public
Date
Signature of notary public
Date
Notary public: affix stamp (or other indication of notary’s authority).
Notary public: affix stamp (or other indication of notary’s authority).
Acknowledgment — partnership by its corporate general partner
State of
ss:
County of
On this
day of
,
,
before me personally came,
Mail completed application to:
to me known, who, being by me duly sworn, did say that he/she reside(s)
at
(insert address)
;
DIRECTOR, REGISTRATION AND DATA SERVICES BUREAU
that he/she is the
of,
NYS TAX DEPARTMENT
(name of corporate general partner) that
BUILDING 8 ROOM 338
W A HARRIMAN CAMPUS
executed the foregoing Paid preparer certification; in its capacity as the
ALBANY NY 12227
general partner of
(name of partnership),
described in the foregoing Paid preparer enrollment; for and on behalf of
the partnership; that he/she knows the corporate seal of such corporation/
general partner; that the seal affixed to such Paid preparer’s certification
is such corporate seal; that it was so affixed by order of the board of
directors of such corporation, and he/she signed his/her name thereby by
like order.
Signature of notary public
Date
Notary public: affix stamp (or other indication of notary’s authority).
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