Form Nyc-Ta03 - New York City Tax Amnesty Application

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New York City Tax Amnesty Application
F I N A N C E
NEW YORK
Amnesty period October 20, 2003 through January 23, 2004
Part 1 - Identifying Information
Please type or print information required. File form DOF-1 to update your information on file with the Department.
Taxpayer Name (individuals enter last name, first name, middle initial)
Trade Name or DBA (if different from legal name)
Social Security Number
Employer Identification Number
Current Mailing Address (number, street, unit, apt.)
City, Town or Post Office
State
ZIP Code
Daytime Telephone Number
Tax Type: (File a separate application for each tax type)
Account ID (if applicable) or Plate No. (see instr.)
Does this application cover a tax and period that is the subject of a pending administrative or court proceeding? ............
YES
NO
If you checked "Yes," you must attach proof of your withdrawal from that proceeding or a stipulation that you will withdraw or discontinue that proceeding as
a condition of being granted amnesty. See Mailing Instructions.
Par t 2 - Tax Liability Information
A. Unfiled or Amended Returns -
Use this section A if you are requesting amnesty with respect to taxes and periods for which you did not previous-
ly file a return or for which you are filing amended returns. Do not use this section if you are requesting amnesty with respect to assessment notices for
taxes and periods for which you previously filed returns.
1
2
3
4
5
Tax period or
Form
Amount of tax
Reduced Interest
Total Amount of tax
tax year
number
due from return
(see instructions)
and interest (Cols. 3 + 4)
a. Total this page
$
$
$
b. Continuation sheet total
$
$
$
c. Total Column 5 lines a & b
$
B. Outstanding Assessments -
Use this section B if you are requesting amnesty with respect to outstanding assessment notices for taxes and peri-
ods for which you previously filed returns. Use section A if you are requesting amnesty for taxes and periods for which you DID NOT previously file returns
even if there is an outstanding assessment for those taxes and periods.
1
2
3
4
5
6
Tax period or
Principal amount of tax
Prior
Balance Due
Reduced Interest
Total amount of tax and
tax year
shown on notice
Payments
(Col. 2 less Col. 3)
(see instructions)
interest due (Cols. 4 + 5)
a. Total this page
$
$
$
$
$
b. Continuation sheet total $
$
$
$
$
c. Total Column 6 lines a & b
$
totals from sections A + B ...............................................
Par t 3 - Total Amnesty Payment
NOTE: The Department will retain any amount paid with this application regardless of whether amnesty is granted. The retention of any payment submitted by a tax-
payer that is the subject of a pending criminal investigation or litigation and whose amnesty application is denied on that basis will not constitute a grant of amnesty
or a settlement, compromise or any other agreement by the Department to discontinue or forego any criminal investigation or prosecution of the taxpayer.
I certify that I am eligible for amnesty and that the information on this application, accompanying
C E R T I F I C A T I O N
returns and schedules, is to the best of my knowledge true, correct, and complete.
Preparer's Telephone Number
I authorize the Dept. of Finance to discuss the processing of this return with the preparer listed below: (see instructions)....YES
S
IGN
Signature
Title
Date
HERE
Preparer's Social Security Number or PTIN
Check if self-
P
'
REPARER
S
Preparer's signature
employed
Date
USE
ONLY
Firm's Employer Identification Number
Firm's name
Address
Zip Code
(or yours, if self-employed)
SEE REVERSE SIDE FOR MAILING INSTRUCTIONS
NYC-TA03
rev. 10/22
00310391

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