Form It-260.1 - Change Of Resident Status - Special Accruals Page 2
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2IT-260.1 (9/13) (back)
4. Standby letter of credit:
Issuer or confirming bank
Amount
Expiration date
Attached and made part of this agreement is the irrevocable standby letter of credit made payable to the New York State
Department of Taxation and Finance.
5. Form W-2G, Certain Gambling Winnings:
Attached and made part of this agreement is a copy of completed federal Form W-2G, which shows that New York State
taxes were withheld on the lottery payments.
Now, therefore, I agree that (1) I will include in my New York personal income tax returns in subsequent taxable
years (or periods) all income and gain accrued prior to my change of residence, as if I had not changed my resident status
and will pay the tax thereon when due; (2) the period of limitation within which tax may be assessed, set forth in Tax Law
section 683, is hereby extended as provided by paragraph (2) of subsection (c) of such section, and I hereby agree that
the tax due may be assessed for any taxable year (or periods) at any time within three years after the tax return relating
to the last taxable year during which income or gain accruing prior to my change of residence is actually received has
been filed; and (3) if the New York State Department of Taxation and Finance determines (a) that I have failed to include
in my New York personal income tax return for any taxable year (or period) any item of income or gain that is required
to be included therein under the terms of this agreement, or to pay any tax required to be paid, or (b) that the security
filed herewith has or will become inadequate to properly secure payment of the tax, the full amount of income which is
accruable under sections 639(a), 639(e), 639(h), 1307(b), 1307(c), 1307(e), and 1307(f ) of the Tax Law shall be accrued
to the portion of the taxable year prior to the change of residence and the additional tax for such period, as recomputed,
shall become due immediately. If such tax is not paid within 30 days after notice of such determination described in
(a) above has been mailed to me by ordinary mail, or if the security that has been determined, as described in (b) above,
to be inadequate to secure payment of the tax is not replaced with adequate security acceptable to the department within
30 days after notice of such determination has been mailed to me by ordinary mail, the New York State Department of
Taxation and Finance may sell, assign, transfer, withdraw or otherwise dispose of said security and apply the proceeds to
any unpaid portion of the tax deferred by reason of the election and any interest and penalties due thereon. The balance of
such proceeds, if any, shall be paid to me.
The above described security is deposited with the understanding that: (1) in case no disposition is made
thereof under the terms of this agreement, such security will be returned to me at such time as the department determines
it is no longer needed as security by reason of the full or partial payment of the tax deferred as a result of the election
under sections 639(d), 639(h), 1307(b), 1307(c), 1307(e), and 1307(f ); and (2) any interest accruing on said security shall
belong to me; and (3) in the case of certificated bonds, in coupon form, the coupons will be detached and forwarded to me
as they become due.
Signature of taxpayer
Date
(if joint return)
Spouse’s signature
261002130094
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