Form St-100.1 - Quarterly Schedule W - Report Of Purchases Eligible For Credit By A Qualified Empire Zone Enterprise (Qeze) - 2015

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Quarterly Schedule W

Department of Taxation and Finance

Report of Purchases Eligible

File as an attachment to Form ST-100

for Credit by a Qualified

For 3rd quarter tax period:

Empire Zone Enterprise

September 1, 2015, through November 30, 2015

(QEZE)

Include with

Due date:

Form ST-100

Monday, December 21, 2015

316

Sales tax identification number

Legal name

(Print ID number and name as shown on Form ST-100 or Certificate of Authority)

If you were certified by Empire State Development (ESD) on or after April 1, 2009, you may use this schedule only if you

made purchases in the following jurisdictions (see instructions on page 2): Allegany County, Cayuga County, city of Auburn,

Erie County, Herkimer County, Montgomery County, and Niagara County.

Note: You must also complete Form AU-12, Application for Credit or Refund of Sales or Use Tax–Qualified Empire Zone

Enterprise (QEZE), and mail it to the address shown on Form AU-12-I, Instructions for Form AU-12, when you take credits on

this schedule.

Do not use this form to claim a credit for the tax paid on qualifying purchases of motor fuel or diesel motor fuel. You must

use Form FT-500, Application for Refund of Sales Tax Paid on Petroleum Products.

PART 1 – Verify eligibility

–

Empire zone certification number from your Empire Zone Retention Certificate (EZRC) ....

If you were certified by ESD before April 1, 2009, you must have applied for and received Form DTF-81-PC, Qualified Empire Zone

Enterprise (QEZE) Sales Tax Certification, before claiming credits.

Has your business passed the employment test for the tax year ending before the period covered by this schedule to

verify that it is eligible to claim the QEZE credit for this reporting period? (If so, you must mark an X in the box.

If not, stop; you are not eligible for the QEZE credit. Do not file this schedule.) ............................................................................................

PART 2 – Purchases eligible for credit by jurisdiction –

Enter amounts of purchases eligible for credit on the appropriate

jurisdiction line. Only the local jurisdictions listed below are eligible for a credit of local sales tax. If a purchase was made in a local

jurisdiction not listed below, enter the amount on either the New York State only line or the New York State/MCTD line, as applicable.

Note: Only businesses certified by ESD before April 1, 2009, are allowed to claim credits on the New York State only line or the New York

State/MCTD line.

Column A

Column B

Column C

Column D

Column E

Taxing jurisdiction