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DTF-84 (11/06) Page 3 of 4

(1) If the other business entity is not certified with the Tax Department as a QEZE for sales tax purposes,

enter the name, federal employer identification number (EIN), and address of the other business entity:

Other business entity legal name:

Other business entity federal EIN:

Other business entity address:

(2) If the other business entity is certified with the Tax Dept. as a QEZE for sales tax purposes, enter the name, federal EIN, address,

and 7‑digit QEZE number from the other entity’s Form DTF‑81, Qualified Empire Zone Enterprise (QEZE) Sales Tax Certification,

issued by the Tax Department. You must also attach a copy of the other business entity’s Form DTF‑81. Note: Your business will be

eligible for QEZE sales tax exemptions as of the effective date on your Form DTF‑81, and your benefit period will extend only for

the remainder of the other business entity’s existing benefit period.

Other business entity name:

Other business entity federal EIN:

Other business entity address:

Other business entity 7 digit QEZE sales tax number:

(b) Is your business entity substantially similar in ownership and operation to an existing or previously existing business

entity taxable, or previously taxable, under Tax Law, Article 9, section 183, 184, 185, or 186; Article 9‑A, 32,

or 33; Article 23 (or that would have been subject to Article 23 as this article was in effect January 1, 1980);

or a business entity for which the income or losses were included for your taxes under Article 22? ............................. Yes

• If No, mark an X in the New business box at the top of Step 5, Employment test, and skip to Step 6.

• If Yes, you do not qualify as a new business and are not eligible for QEZE sales tax benefits. Do not continue

with Step 5, and do not submit this application.

Step 5 – Employment test

New business:

If you qualify as a new business in Step 4 above, mark an X in the box to the right and skip to Step 6. ...........................................................

As a new business, you will qualify for QEZE sales tax exemptions for each tax year in which you have full‑time employees.

If you are not a new business, continue with the employment test below.

Employment test tables:

For the employment test tables in Parts A and B, full‑time employees are individuals, not including general executive officers, employed for at

least half of the tax year in a job of at least 35 hours per week. This includes two or more jobs that together constitute the equivalent of a job

of at least 35 hours per week. A seasonal business (a business that regularly operates for less than an entire tax year, such as a ski resort)

that employs individuals full‑time for at least three months of continuous duration may include these individuals in the employment number

if they are working in a job of at least 35 hours per week. Note: When completing the employment test tables, employment numbers for tax

years beginning on or after January 1, 2002, cannot include individuals employed within the immediately preceding 60 months by a related

person, as defined in Internal Revenue Code (IRC) section 465(b)(3)(C).

Part A

Determine the average number of full‑time employees located in empire zones for both your most recently completed tax year and your base

period, as indicated below. To qualify for QEZE sales tax exemptions, the average number of empire zone employees for your most recently

completed tax year must exceed the average number of empire zone employees for your base period.

Employees within empire zones

Column G

Column F

Average number of employees

Total

(divide total in Col. F by the number of

Column A

Column B Column C Column D Column E

(B + C + D + E)

entries in B through E)

Year

March 31

June 30

Sept 30

Dec 31

Enter in Column A the dates of your business’s

most recently completed tax year. Enter in

Columns B through E, for the dates shown, the

total number of full‑time employees within empire

zones. Note: This might not be the tax year listed in

Step 3(a).

Enter in Column A, lines 2 through 6, the tax years

in the base period from Step 3(b). (Base period

year 1 is the oldest year, base period year 3 is the

Column F

most recent.) Enter in Columns B through E, lines 2

Total

through 4, for the dates shown, the total number of

Column A

Column B Column C Column D Column E

(B + C + D + E)

Year

March 31

June 30

Sept 30

Dec 31

full‑time employees within empire zones.

Base period year 1:

Base period year 2:

Base period year 3:

Total number of full‑time employees within empire zones during the base period

. .................. 5.

(add boxes 2 through 4)

Average number of full‑time employees within empire zones during the base period

. ................................................................... 6.

(divide the total in box 5 by the number of entries in Columns B through E, lines 2 through 4)

(continued)

Form Dtf-84 - Application For Qualified Empire Zone Enterprise Sales Tax Certification Page 3

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