Form Dtf-17-Att - Schedule Of Business Locations For A Consolidated Filer Page 2
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2Page 2 of 2 DTF-17-ATT (2/12)
Legal name
Sales tax ID number
To list more locations, photocopy this schedule, as needed.
DBA or trade name (if different from legal name above)
Street address (number and street)
City
U.S. state/Canadian province
ZIP/Postal code
County
Country
Business phone number
Date business will
begin at this location:
(
)
DBA or trade name (if different from legal name above)
Street address (number and street)
City
U.S. state/Canadian province
ZIP/Postal code
County
Country
Business phone number
Date business will
begin at this location:
(
)
DBA or trade name (if different from legal name above)
Street address (number and street)
City
U.S. state/Canadian province
ZIP/Postal code
County
Country
Business phone number
Date business will
begin at this location:
(
)
DBA or trade name (if different from legal name above)
Street address (number and street)
City
U.S. state/Canadian province
ZIP/Postal code
County
Country
Business phone number
Date business will
begin at this location:
(
)
DBA or trade name (if different from legal name above)
Street address (number and street)
City
U.S. state/Canadian province
ZIP/Postal code
County
Country
Business phone number
Date business will
begin at this location:
(
)
DBA or trade name (if different from legal name above)
Street address (number and street)
City
U.S. state/Canadian province
ZIP/Postal code
County
Country
Business phone number
Date business will
begin at this location:
(
)
DBA or trade name (if different from legal name above)
Street address (number and street)
City
U.S. state/Canadian province
ZIP/Postal code
County
Country
Business phone number
Date business will
begin at this location:
(
)
Signature of responsible person – Complete all fields
I certify that the above statements are true, complete, and correct, and that no material information has been omitted. I make these
statements with the knowledge that willfully providing false or fraudulent information with this document may constitute a felony or other
crime under New York State Law, punishable by a substantial fine and possible jail sentence. I also understand that the Tax Department is
authorized to investigate the validity of any information entered on this document.
Name
SSN
Date
Signature
Title
Daytime telephone number
(
)
If your application is missing information or is not signed, we will return it to you.
See Form DTF-17-I, Instructions for Form DTF-17, for Need help? and mailing information.
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