Form St-101.1 - Annual Schedule W - Report Of Purchases Eligible For Credit By A Qualified Empire Zone Enterprise (Qeze) - 2015
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1
2Annual Schedule W
New York State Department of Taxation and Finance
W
Report of Purchases Eligible for
File as an attachment to Form ST-101
Credit by a Qualified Empire Zone
For tax period:
Enterprise (QEZE)
March 1, 2014, through February 28, 2015
Include with
Due date:
Form ST-101
Friday, March 20, 2015
A15
Sales tax identification number
Legal name
(Print ID number and name as shown on Form ST-101 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
: Allegany County, Cayuga
(see instructions on page 2)
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
Jurisdiction
Eligible purchases
Tax rate
Amount of sales and use tax credit
code
(C × D)
New York State only
NE W0021
.00
4%
/
3
New York State/MCTD
NE W8061
.00
4
%
8
/
1
Allegany County
AL W0221
.00
8
%
2
Cayuga County
CA W0511
.00
8%
Auburn (city)
AU W0561
.00
8%
/
3
Erie County
ER W1451
.00
8
%
4
/
1
Herkimer County
HE W2121
.00
8
%
4
Montgomery County
MO W2781
.00
8%
Niagara County
NI W2911
.00
8%
Column totals:
.00
Include this amount as a negative on
Include this amount as a negative
Form ST-101, page 2, Column D, in box 4.
on Form ST-101, page 2, Column F, in
box 5. ( See instructions on page 2.)
ST-101
W
Insert Form ST-101.1
inside Form ST-101
10100102150094
ST-101.1 (2/15) Page 1 of 2
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