Form Dtf-17 - Application To Register For A Sales Tax Certificate Of Authority Page 2
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5Page 2 of 6 DTF-17 (12/10)
Section B — Type of entity or organization
(continued)
12a Are you a franchisee? ........................................................................................................................................... 12a.
Yes
No
12b If Yes, provide franchisor’s name and address:
Franchisor’s name
Franchisor’s address
(number and street)
City
U.S. state/Canadian province
ZIP/ Postal code
Country
Section C — Business information
(see instructions)
If you have more than one permanent place of business, mark an X in the appropriate box to indicate how you will file.
13a Separate sales tax returns for each location
......................................... 13a.
(you must complete a separate Form DTF-17 for each location)
13b One sales tax return for all locations
................................................................................ 13b.
(you must also complete Form DTF-17-ATT)
14a If you or your business currently file, have filed in the past, or were required to file sales tax returns or returns for other NYS business
taxes, such as corporation tax or withholding tax, enter the ID number(s) below.
•
ID number
Tax type
•
ID number
Tax type
•
ID number
Tax type
14b Were you previously registered to collect sales tax, but your Certificate of Authority expired or was
surrendered, revoked, or suspended? ............................................................................................................................ 14b.
Yes
No
14c
If Yes, provide the ID number from your previous business (if available) .............................................. 14c.
15 You can choose to register as a temporary vendor if your business does not expect to make taxable sales
for more than two consecutive sales tax quarters
. Provide the date that your business
(see instructions)
............................................................................................................................... 15.
activity will end
(mm/dd/yy)
16 If you acquired all or part of the assets of a business that was registered (or required to be registered) for sales tax,
did you file Form AU-196.10, Notification of Sale, Transfer, or Assignment in Bulk, with the Tax Department? ... 16.
Yes
No
Information about former business owner:
Name
Sales tax ID number
Address
City
U.S. state / Canadian province ZIP / Postal code
Country
(number and street)
Section D — Business activity
Mark an X in the applicable box for each item
.
(see instructions)
Licenses
17a Are you or do you intend to be licensed by the NYS Liquor Authority (SLA)? ................................................ 17a.
Yes
No
17b If Yes, enter your SLA license number (if available). ................................................................................... 17b.
18a Are you or do you intend to be licensed by the NYS Lottery? ....................................................................... 18a.
Yes
No
18b If Yes, enter your Lottery retailer number (if available). .............................................................................. 18b.
19a Do you or will you operate a facility registered with the NYS Department of Motor Vehicles (DMV)? ............. 19a.
Yes
No
19b If Yes, enter your DMV facility number (if available). .................................................................................. 19b.
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