Form Dtf-719-Mn - Renewal Application For Registration Of Retail Dealers And Vedning Machines For Sales Of Cigarettes And Tobacco Products
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4DTF-719-MN
New York State Department of Taxation and Finance
Renewal Application for Registration of
(6/06)
Retail Dealers and Vending Machines for
C07
Sales of Cigarettes and Tobacco Products
Use this form to renew registration for all or any portion of the period from
January 1, 2007, through December 31, 2007.
Date
Legal name of business
DBA (doing business as)/trade name
Sales tax vendor identification number
Mailing address: c/o name
Number and street
City, state, ZIP code
Read the instructions (Form DTF-719-I) before completing this form.
Use this form to renew the registration for retail dealer certificates and vending machine certificates only if you are
currently registered for the year 2006. If registering for the first time, use Form DTF-716 , Application for Registration
of Retail Dealers and Vending Machines for Sales of Cigarettes and Tobacco Products. (See General information and
When to File on Form DTF-719-I.)
1. Business telephone number: (
)
2. Change of mailing address:
Mark an X here if you have changed your mailing address. Enter this new address in the area above.
3. Mark an X in the box(es) that describes how the cigarettes or tobacco products are sold at retail:
Retail locations
Carts, trucks, stands, etc.
Vending machines
A
B
C
D
Number
Cost of each
Amount due
Code
(A x B)
4.
Certificates of registration
$100
$
7007
. . . .
(from Part A; see instructions)
5.
Vending machine registration certificates
. . . . . . . . . . . . . . . . . . . . . . . .
$25
$
7008
(from Part B; see instructions)
6.
Total amount due
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$
(add lines 4 and 5, column C)
Note: Vending machine registration certificates and certificates of registration for the
For office use only
period January 1, 2007, through December 31, 2007, will not be issued before
December 1, 2006.
Attach check or money order for the amount on line 6 payable to New York State Sales Tax.
Write your sales tax vendor identification number, Form DTF-719 , and the year for which
you are registering on the front of your check or money order.
Mail your application and remittance on or before September 20, 2006.
Do not mail this application in the envelope provided with
your sales tax return.
Mail to:
Signature of applicant
NYS TAX DEPARTMENT
Title
JAF BUILDING
PO BOX 1222
NEW YORK NY 10116-1222
Daytime telephone number
Date
(
)
DTF-719-MN (6/06)
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