Form St-810.1 - Quarterly Schedule W For Part-Quarterly (Monthly) Filers - Report Of Purchases Eligible For Credit By A Qualified Empire Zone Enterprise (Qeze) - 2015
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1
2Quarterly Schedule W for
W
Part-Quarterly (Monthly) Filers
Department of Taxation and Finance
Report of Purchases Eligible for
File as an attachment to Form ST-810
Credit by a Qualified Empire
For 3rd quarter tax period:
Zone Enterprise (QEZE)
September 1, 2015, through November 30, 2015
Include with
Form ST-810
Due date:
0916
Monday, December 21, 2015
Sales tax identification number
Legal name
(Print ID number and name as shown on Form ST-810 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%
New York State/MCTD
NE W8061
.00
4⅜%
Allegany County
AL W0221
.00
8½%
Cayuga County
CA W0511
.00
8%
Auburn (city)
AU W0561
.00
8%
Erie County
ER W1451
.00
8¾%
Herkimer County
HE W2121
.00
8¼%
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-810, page 2, Column D, in box 4.
on Form ST-810, page 2, Column F, in
box 5. ( See instructions on page 2.)
ST-810
W
Insert Form ST-810.1
inside Form ST-810
80100111150094
ST-810.1 (11/15) Page 1 of 2
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