Form Dtf-17 - Application To Register For A Sales Tax Certificate Of Authority Page 3

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DTF-17 (12/10) Page 3 of 6

Section D — Business activity

(continued)

Sales of goods and services

D o you intend to sell or provide any of the following goods and services?

20a Cigarettes or other tobacco products sold at retail ....................................................................................... 20a.

Yes

If Yes, complete and attach Form DTF-716, Application for Registration of Retail Dealers

and Vending Machines for Sales of Cigarettes and Tobacco Products.

20b New tires (automotive, motorcycle, trailer, etc.) ........................................................................................... 20b.

Yes

20c Passenger car rentals ................................................................................................................................... 20c.

Yes

20d Motor fuel sold at a filling station .................................................................................................................. 20d.

Yes

20e Diesel motor fuel sold at a filling station ....................................................................................................... 20e.

Yes

20f Heating fuels, including diesel, firewood, pellets, or coal ............................................................................

20f.

Yes

20g Electricity or gas (including propane in containers of 100 pounds or more), steam, or refrigeration ........... 20g.

Yes

20h Mobile telecommunications service ............................................................................................................ 20h.

Yes

20i Other telecommunications service, including telephone answering service ................................................

20i.

Yes

20j Clothing or footwear .....................................................................................................................................

20j.

Yes

20k Hotel, motel, or other accommodations located in Nassau County or Niagara County .............................. 20k.

Yes

20l Restaurant or tavern food or drink, or other food service (including catering, take-out, cafeterias, etc.)

located in Nassau County or Niagara County .............................................................................................

20l.

Yes

20m Admissions to places of amusement, club dues, and/or cabaret charges located in Niagara County ........ 20m.

Yes

New York City only:

20n Parking or garaging services ........................................................................................................................ 20n.

Yes

20o Interior decorating or design services .......................................................................................................... 20o.

Yes

20p Beauty, barbering, or miscellaneous personal services ............................................................................... 20p.

Yes

20q Interior cleaning or maintenance services ................................................................................................... 20q.

Yes

20r Protective or detective services ...................................................................................................................

20r.

Yes

20s Credit rating or reporting services ................................................................................................................ 20s.

Yes

20t Hotel, motel, or other accommodations ......................................................................................................

20t.

Yes

Other:

20u Are you a manufacturer or a wholesaler that does not make retail sales? ................................................... 20u.

Yes

20v Will you participate solely in flea markets, antique shows, or other shows? .............................................. 20v.

Yes

20w Will you conduct business solely as a sidewalk vendor? ............................................................................ 20w.

Yes

Section E — Account and reporting information

21 Enter the information for the bank account where sales tax money will be deposited. You must provide this information even if the

account you list will not be used exclusively for sales tax purposes.

Manufacturers and wholesalers: enter the primary bank account information for your business.

Bank name

Routing number

Account number

22 Do you intend to accept credit cards? ................................................................................................................... 22. Yes

23 If this is not the entity that will be reporting the income from the operations of this business on an income tax return or corporation

tax return, enter the name and EIN of the legal entity or social security number (SSN) for the individual t hat will be reporting the income

from the operations of the business filing sales and use tax returns.

Name of legal entity or individual

EIN or SSN