Form Dtf-17 - Application To Register For A Sales Tax Certificate Of Authority Page 4
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5Page 4 of 6 DTF-17 (12/10)
Section F — Business description
(see instructions)
24a In the space below, briefly describe your business activities. Describe the products or services that you will sell in NYS from the business
location(s) that you are registering. Please be specific. See the instructions for examples.
Enter the NAICS code that best describes the principal (and secondary, if appropriate) activity of the business location(s) that you
are registering. You can find a list of NAICS codes in Publication 910, Principal Business Activity for New York State Purposes, or by
using the online NAICS Code Lookup on our Web site (see Need help? in Form DTF-17-I).
24b Principal NAICS code (required)
24c Secondary NAICS code
Section G — Responsible person(s)
(see instructions)
Enter the applicable information for all responsible persons (see instructions). This includes, but is not limited to, owners, partners,
members, officers, and any other person responsible for the business’s day-to-day operations. You must provide all the information that we
ask for, including SSN. Attach a separate sheet if necessary.
Name
Business title
(first, middle initial, last, suffix)
25
Home address
City
U.S. state /Canadian province
ZIP/ Postal code
Country
(number and street; not a PO Box)
SSN
Home phone number
Effective date of assuming responsibility
( )
Primary duties
E-mail address
All responsible persons must complete the following — except those in
Ownership
Profit distribution percentage, if different than
C corporations, government entities, trusts, and estates ........................... percentage if over 5%:
ownership percentage and if over 5%:
Name
Business title
(first, middle initial, last, suffix)
Home address
City
U.S. state /Canadian province
ZIP/ Postal code
Country
(number and street; not a PO Box)
SSN
Home phone number
Effective date of assuming responsibility
( )
Primary duties
E-mail address
All responsible persons must complete the following — except those in
Ownership
Profit distribution percentage, if different than
C corporations, government entities, trusts, and estates ........................... percentage if over 5%:
ownership percentage and if over 5%:
Name
Business title
(first, middle initial, last, suffix)
Home address
City
U.S. state /Canadian province
ZIP/ Postal code
Country
(number and street; not a PO Box)
SSN
Home phone number
Effective date of assuming responsibility
( )
Primary duties
E-mail address
All responsible persons must complete the following — except those in
Ownership
Profit distribution percentage, if different than
C corporations, government entities, trusts, and estates ........................... percentage if over 5%:
ownership percentage and if over 5%:
Name
Business title
(first, middle initial, last, suffix)
Home address
City
U.S. state /Canadian province
ZIP/ Postal code
Country
(number and street; not a PO Box)
SSN
Home phone number
Effective date of assuming responsibility
( )
Primary duties
E-mail address
All responsible persons must complete the following — except those in
Ownership
Profit distribution percentage, if different than
C corporations, government entities, trusts, and estates ........................... percentage if over 5%:
ownership percentage and if over 5%:
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