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

Is the employment number in box 1 greater than the employment number in box 6? ...................................................

Yes

• If No, stop; you are not eligible at this time for QEZE sales tax exemptions. Do not continue to Step 6 and do not file this application. When

your business’s current tax year ends, you may complete this application again to determine your eligibility for QEZE sales tax exemptions.

• If Yes, proceed below.

Part B

Determine the average number of full‑time employees located within New York State, including empire zones. To qualify for QEZE sales tax

exemptions, the average number of employees located in New York State, including empire zones, for your most recently completed tax year

must exceed the average number of employees located in New York State, including empire zones, for your base period.

Employees in New York State, including 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 in New York State

including empire zones. Note: This might not be the

tax year listed in Step 3(a).

Enter in Column A, lines 10 through 14, the tax years

in the base period from Step 3(b). (Base period year 1

is the oldest year, base period year 5 is the most

Column F

recent.) Enter in Columns B through E, lines 8 through

Total

10, for the dates shown, the total number of full‑time

Column A

Column B Column C Column D Column E

(B + C + D + E)

Year

March 31

June 30

Sept 30

Dec 31

employees in New York State, including empire zones.

Base period year 1:

Base period year 2:

10.

Base period year 3:

10.

11.

Total number of full‑time employees in New York State, including empire zones, during the base period

. ............................................................................................................................................. 11.

(add boxes 8 through 10)

12.

Average number of full‑time employees in New York State, including empire zones, during the base period

. ................................................................ 12.

(divide the total in box 11 by the number of entries in Columns B through E, lines 8 through 10)

Is the employment number in box 7 greater than the employment number in box 12? .................................................

Yes

• If No, stop; you are not eligible at this time for QEZE sales tax exemptions. Do not file this application. When your business’s current

taxable year ends, you may complete this application again to determine your eligibility for QEZE sales tax exemptions.

• If Yes, you meet the employment test requirements and you can file this application. If the Tax Department approves your application, you

will receive Form DTF‑81, Qualified Empire Zone Enterprise (QEZE) Sales Tax Certification. You can begin to make tax‑exempt purchases

as of the Effective date printed on your Form DTF‑81.

Step 6

I certify that the information in this application is true and correct. Willfully filing a false application is a misdemeanor punishable under the Tax Law.

Print name

Title

Signature

Date

This application will be returned if it is not signed or if any other information is missing.

Form Dtf-84 - Application For Qualified Empire Zone Enterprise Sales Tax Certification Page 4

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