Form Dtf-350 - Group Affidavit - New York State Department Of Taxation And Finance
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1
2New York State Department of Taxation and Finance
DTF-350
Group Affidavit
(6/12)
Submit with: Form TR-99, IT-203-GR, IT-203-S, or IT-203-TM; or
MTA-599 or MTA-505
State of
Special NYS identification number
( see instructions )
County of
being duly sworn, states:
I reside at
in the city/town/village/borough, etc.,
of
, State of
, ZIP code
1. Partnerships or S corporations - I am a partner in the firm of
or a shareholder of
, which is described in the accompanying application, Form TR-99, or Form MTA-599
or group return, Form IT-203-GR, Form IT-203-S, or Form MTA-505, whichever is applicable, for the tax year ending
the
day of
, 20
; or
2. Athletic teams - I am associated with the group , which is described in the accompanying application, Form TR-99, or group
return, Form IT-203-TM, 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:
resident or nonresident partner subject to the
nonresident
nonresident
nonresident
partner
shareholder
team member
metropolitan commuter transportation mobility tax
(hereinafter referred to as group members) named, listed or otherwise described in the accompanying application or group return, and
any 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, and Article 23 of the Tax Law.
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 the New York State Penal
Law; 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 Article 37 of the New York State Tax Law.
Signature of group agent
Sworn to before me this
day of
, 20
Print name beneath signature
(
)
Daytime phone number
Notary Public
My commission expires
E-mail address
350001120094
3501120094
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