Application For Tax Status Report Form - Nyc Department Of Finance
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1FOR OFFICE USE ONLY
A A P P P P L L I I C C A A T T I I O O N N F F O O R R
: __________
DATE RECEIVED
: _____________
T T A A X X S S T T A A T T U U S S R R E E P P O O R R T T
F I N A N C E
TSA NUMBER
NEW
YORK
: _______________
AUDITOR
G
THE CITY OF NEW YORK
DEPARTMENT OF FINANCE
n y c . g o v / f i n a n c e
Type or Print
Applicant's name
Date
Applicant's address
(Number and Street)
City and State
Zip Code
Telephone number
Name of subject corporation
Subject corporation's address
(Number and Street)
City and State
Zip Code
Employer Identification Number
State or County of incorporation
Date of incorporation
Date business began in NYC
C E R T I F I C AT I O N
I hereby certify that the statements made herein have been examined by me and are, to the best of my knowledge and belief, true, correct and complete.
SIGN
¡
DATE
HERE
__________________________________________________________________________
________________________________
RELATIONSHIP TO
K
K
CORPORATION
REPRESENTATIVE
OFFICER
(Check one)
(see instructions)
IN S T R U C T I O N S
1. Please complete this application in its entirety. Incomplete applications cannot be processed and
will be rejected.
2. The processing fee for the Application for Tax Status Report is $5.00. Make check or money order
payable to: NYC Department of Finance. This fee is non-refundable.
3. A fully executed Power of Attorney form must be submitted by any authorized representative of the
subject corporation requesting a tax status report.
4. Mail this completed application, the $5.00 processing fee and completed Power of Attorney form (if
applicable) to:
NYC Department of Finance
Collections Division
Vendex/Vendor Clearance Unit
59 Maiden Lane, 25th Floor
New York, NY 10038
5. If you have any questions, call Customer Relations at (212) 232-1828/1829/1830/1831.
Tax Status Application 2008
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