Form St-141 - Individual Purchaser'S Periodic Report Of Sales And Use Tax (Page 3 of 3) in pdf

Form St-141 - Individual Purchaser'S Periodic Report Of Sales And Use Tax Page 3

ST-141 (3/15) Page 3 of 3

Part 2 – All other taxable items and services

List all other taxable items or services, including taxable clothing and footwear each costing $110 or more, on which no New York State or local

tax was collected from you at the time of purchase, or on which you owe additional local tax (see instructions). Shipping and handling charges

must be included in column A when computing your tax due. Attach additional sheets if necessary. If any item or service purchased cost

$25,000 or more each, excluding shipping and handling, you must also complete Form IT-135 and attach it to this form.

Note: Any unpaid sales or use tax on a motor vehicle, trailer, all-terrain vehicle, vessel, or snowmobile that must be registered or titled by the

New York State Department of Motor Vehicles is collected at the time of registration. Therefore, do not report or pay the sales or use tax on

these items on this form.

Purchase price

Combined

Tax

Tax paid to another

Tax due

state and local rate

taxing jurisdiction, if any

(see instructions)

(multiply column A

(subtract column D from column C;

(from Chart 1;

by column B)

(see instructions)

do not enter less than zero)

see instructions)

2 Total

..................................................

(add the Part 2, column E amounts; do not enter less than zero)

3 Add lines 1 and 2; transfer this amount to the Computation of total sales or use tax due

section, line 3 on page 1 of this form .............................................................................................

I certify that the above statements are true and correct, and I make these statements with the knowledge that willfully issuing a false or

fraudulent document with the intent to evade tax may constitute a felony under New York State Tax Law, punishable by a substantial fine and

a possible jail sentence. I also understand that the Tax Department is authorized to investigate the validity or the accuracy of any information

entered on this document.

Purchaser’s signature

Date

Telephone number of purchaser

(

)

Printed name of preparer

Preparer’s PTIN

(if other than purchaser)

Preparer’s address

Preparer’s NYTPRIN

Excl. code

Preparer’s signature

Preparer’s telephone number

(if other than purchaser)

(

)

44100303150094

Form St-141 - Individual Purchaser'S Periodic Report Of Sales And Use Tax Page 3

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