Form Dtf-350 - Group Affidavit - Department Od Taxation And Finance

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DTF-350 (11/00)
Group Affidavit
Attach to Form PR-99, IT-203-GR, IT-203-S, IT-203-TM or IT-203-GG
State of _____________________
County of ____________________
__________________________________________________________________________________ being duly sworn, states:
I reside at _________________________________________________________________________________ in the city/town/village/
borough, etc., of _________________________________________________________________, State of ________________________.
(1) Partnerships or S Corporations - I am a partner in the firm of ______________________________________________________,
or a shareholder of ____________________, which is described in the attached application, Form PR-99 or the attached group return, Form
IT-203-GR or Form IT-203-S, whichever is applicable, for the tax year ending the _____ day of ______________, 20 ____ ; or (2) Athletic
Teams and Other Nonresident Groups - I am associated with the group ______________________________, which is described in the
attached application, Form PR-99 or the attached group return, Form IT-203-TM or Form IT-203-GG, whichever is applicable, for the tax year
ending the _____ day of ___________, 20 ____.
I have been duly and properly designated and authorized under the laws of the State of New York and the laws of any other state, if
applicable, to act as agent, for the purposes described herein, for each and every New York:
nonresident partner
nonresident shareholder
nonresident team member
other nonresident group member
(hereinafter referred to as group members ) named, listed or otherwise described in the attached application or group return, and any
attachment, schedule or list appended thereto, which application or group return I am signing and filing with the New York State Department
of Taxation and Finance on behalf of the group members .
As agent, I am authorized to receive confidential information and to perform any and all acts that each of the group members can perform
with respect to making, executing and filing this application or return. By reason of this delegation of authority from each of the group
members, I am acting as a common partner or group representative (hereinafter referred to as group agent ) pursuant to 20 NYCRR section
151.17 of the Regulations of the New York Commissioner of Taxation and Finance.
I am submitting this affidavit with the understanding that the New York State Department of Taxation and Finance will rely upon it; and I
am aware that offering a false instrument for filing is a class A misdemeanor or a class E felony under sections 175.30 and 175.35 of the
Penal Law of the State of New York; and supplying false information, filing a false return and aiding or assisting in the giving of fraudulent
returns, reports, statements or other documents constitute misdemeanors and felonies under sections 1801, 1804 and 1807 of the New York
State Tax Law.
_____________________________________________
Print name beneath signature
Sworn to before me this
_______ day of __________________, 20____
______________________________________
Notary Public
My commission expires ________________________

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