Form It-260.1 - Change Of Resident Status - Special Accruals
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1
2New York State Department of Taxation and Finance
IT-260.1
Change of Resident Status - Special Accruals
(9/99)
Tax Law — Sections 639(a), 639(d), 639(e), 1307(b) and 1307(d)
Attach to Form IT-203 or IT-205.
Complete this agreement in triplicate and forward by registered mail to: NYS Tax Department, Division of the Treasury, Cash
Management Unit, PO Box 7002, Albany NY 12225-7002. If filing a joint return, include both names.
Whereas, I, (name)________________________________________________________________________ , of
(address as shown on return) __________________________________________________________________________ ,
have changed my status for New York State and/or city of New York personal income tax purposes from that of a resident to
that of a nonresident on (date) _____________________________________ , and
Whereas, I elect, pursuant to sections 639(a), 639(e), 1307(b) and 1307(d) of the Tax Law, to file my New York
personal income tax return for the period prior to my change of residence on the cash receipts basis, and
Whereas, the tax, as determined pursuant to sections 639(a), 639(e), 1307(b) and 1307(d) for the portion of the
taxable year prior to my change of residence would have been increased by the amount of $ _________________________
if such election had not been made, and
Whereas, I hereby deposit with you the following described security:
I.
Certificated U.S. treasury bonds:
Market value
Registration or
Par or
(as of date of
Due
certificate number
face value
filing with Department)
Attached and made part of this agreement is a properly completed U.S. Treasury Form, PD 1832, assigning said
securities to the New York State Department of Taxation and Finance.
II.
Certificated New York State bonds or bonds of any political subdivision thereof:
Market value
Registration or
Par or
(as of date of
Description
Due
certificate number
face value
filing with Department)
Attached and made part of this agreement is a properly completed New York State Form AU-217, Assignment Separate
from Bond, assigning said securities to the New York State Department of Taxation and Finance.
III. Bank passbooks and/or certificates of deposit:
If certificate of deposit,
Bank/financial institution
Amount
maturity date
Attached and made part of this agreement is a letter prepared on the letterhead of the bank/financial institution and
signed by an officer thereof: a) identifying the passbooks or certificates of deposit by account number and confirming that
withdrawal of principal from the passbook or certificate of deposit will not be permitted without written consent from the
New York State Department of Taxation and Finance, and b) stating that any right of set-off which the bank/financial
institution may possess against the taxpayer resulting from a defaulted obligation of such taxpayer shall be subordinate
to the interest of the department in the passbook or certificate of deposit offered as collateral.
IT-260.1 (9/99)
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