Form St-140 - Individual Purchaser'S Annual Report Of Sales And Use Tax

Form St-140 - Individual Purchaser'S Annual Report Of Sales And Use Tax - 2013 Page 4

Page 4 of 4 ST-140 (2013)

I certify that the above statements are true and correct, and I make these statements with the knowledge that willfully issuing a false or fraudulent

document with the intent to evade tax may constitute a felony under New York State Tax Law, punishable by a substantial fine and a possible jail

sentence. I also understand that the Tax Department is authorized to investigate the validity or the accuracy of any information entered on this

document.

Purchaser’s signature

Date

Telephone number for purchaser

(

)

Printed name of preparer

Preparer’s PTIN

(if other than purchaser)

Preparer’s address

Preparer’s NYTPRIN

Preparer’s signature

Preparer’s telephone number

(if other than purchaser)

(

)

Mail this return and remittance to:

NYS TAX DEPARTMENT

TRANSACTION DESK AUDIT BUREAU — CASUAL SALES UNIT

W A HARRIMAN CAMPUS

ALBANY NY 12227

Private delivery services

If you choose, you may use a private delivery service, instead of the U.S. Postal Service, to mail in your form and tax payment. However,

if, at a later date, you need to establish the date you filed or paid your tax, you cannot use the date recorded by a private delivery service

unless you used a delivery service that has been designated by the U.S. Secretary of the Treasury or the Commissioner of Taxation and

Finance. (Currently designated delivery services are listed in Publication 55, Designated Private Delivery Services. See Need help? below

for information on obtaining forms and publications.) If you have used a designated private delivery service and need to establish the date

you filed your form, contact that private delivery service for instructions on how to obtain written proof of the date your form was given to

the delivery service for delivery.

Need help?

Visit our Web site at

• get information and manage your taxes online

• check for new online services and features

Sales Tax Information Center:

(518) 485-2889

To order forms and publications:

(518) 457-5431

Text Telephone (TTY) Hotline

(for persons with hearing and

speech disabilities using a TTY):

(518) 485-5082

4400400130094

Form St-140 - Individual Purchaser'S Annual Report Of Sales And Use Tax - 2013 Page 4

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