Form Dtf-716 - Application For Registration Of Retail Dealers And Vending Machines For Sales Of Cigarettes And Tobacco Products Page 2
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1
2
3DTF-716
New York State Department of Taxation and Finance
Application for Registration of Retail Dealers and Vending
(6/09)
Machines for Sales of Cigarettes and Tobacco Products
C10
Note: To receive your certificate(s) faster, apply online at For more information, see Form DTF-716-I, Instructions for Form DTF-716.
Use this form to register for all or any portion of the period from January 1, 2010, through December 31, 2010.
Legal name of business
Date
DBA/trade name
Sales tax vendor identification number
Mailing address: c/o (name)
Business telephone number
(
)
Number and street
City, state, ZIP code
See instructions before completing this form.
You must be registered for New York State sales tax if you are selling cigarettes or tobacco products at retail.
Mark an X in the box that applies:
Registered sales tax vendor
Form DTF-17, Application to Register for a Sales Tax
Certificate of Authority (enclosed)
Mark an X in the box that applies:
New applicant
Registering additional locations or vending machines
Mark an X in the box(es) that describes how the cigarettes or tobacco products are sold at retail:
Retail locations
Merchandising devices
Cart(s)
Truck(s)
(mark as applicable):
Vending machines
Stand(s)
Other (describe)
1. Date you began or will begin business in New York State: 2. Date you began or will begin selling cigarettes or other tobacco
products at retail or through vending machines in New York State:
3. Type of organization (mark an X in the box that applies):
Individual
Trust
Partnership
Corporation
Governmental
Exempt organization
Other (specify):
Certificates of registration for business location
Fee scale: Gross sales for business location for period
A
B
C
D
1/1/08 - 12/31/08
Number
Cost of Each
Amount due
Code
(A × B)
4. $0 - $999,999.99
....................................................
$1,000
$
7011
(from Part A, column B)
5. $1,000,000 - $9,999,999.99
...................................
$2,500
$
7025
(from Part A, column C)
6. $10,000,000 and over
.............................................
$5,000
$
7021
(from Part A, column D)
7. Certificate of registration totals
.......
$
(add lines 1, 2, and 3, columns A and C)
Vending machine registration certificates
A
B
C
D
Fee scale: Gross sales for vending machine for period
1/1/08 - 12/31/08
Number
Cost of Each
Amount due
Code
(A × B)
8. $0 - $99,999.99
.......................................................
$ 250
$
7035
(from Part B, column B)
9. $100,000 - $999,999.99
.........................................
$ 625
$
7031
(from Part B, column C)
10. $1,000,000 and over
...............................................
$1,250
$
7045
(from Part B, column D)
11. Vending machine totals
.................
$
(add lines 8, 9, and 10, columns A and C)
12. Total amount due
.................................................................................................... $
(add lines 7 and 11)
— Attach check or money order for the amount on line 12, payable to New York State Sales Tax.
— Write your sales tax vendor identification number, DTF-716, and the year for which you are registering on the front of your check or money order.
— Mail your application and remittance to:
NYS TAX DEPARTMENT
PO BOX 15175
ALBANY NY 12212-5175
Do not mail this application in the envelope with your sales tax return.
Signature of applicant
Telephone number
For office use only
(
)
Title
Date
7160106090094
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