Form Tr-684 - Promptax - Motor Fuel And Petroleum Business Taxes (Articles 12-A And 13-A) Request For Hardship Exemption Page 2
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2TR-684 (12/11) (back)
Instructions
The selection of businesses for mandatory participation in the
Line d
Enter the total Article 12-A and 13-A taxes for
Electronic Funds Transfer (EFT) program is based on historical
the six-month period immediately preceding the
tax liability. The hardship exemption was established to account
most recent six-month period from line a and the
for a significant decrease in tax liability from the historical
beginning and ending month/year for the period.
selection period to a more current period.
Example: For the period 3/06 through 8/06, the
You may qualify for hardship exemption if:
figure is $3,000,000.
1. The tax liability for the most recent six-month period is less
Line e
Multiply line c by line d and enter the result.
than 50% (0.5) of the tax liability for the same six-month
Example: .263 × $3,000,000 equals $789,000.
period of the prior year; and
2. The tax liability for the most recent six-month period plus
Line f
Add line a and line e. This total must be less than
the tax liability for the six-month period preceding the
$2.5 million in order to satisfy the second statutory
most recent six-month period multiplied by the percentage
hardship exemption criterion.
calculated in 1. above is less than $2.5 million.
Example: The total of line a and line e is
If you believe you qualify for exemption based on criteria
$2,289,000.
described in Tax Law section 10(b)(4), you may submit
Mark an X in the box next to each exemption criterion that
Form TR-684 to the Tax Department. To be considered for
has been met. In order to qualify for hardship exemption
exemption, you must meet the stated criteria.
consideration, both criteria must be met. XYZ Corporation has
To determine the tax amount for each six-month period, include
met both exemption criteria.
both the tax liability shown on the applicable Form PT-100
Certification section
(line 13) filed and any subsequent audit adjustments.
This form must be signed and dated by an individual authorized
Business information — Enter your taxpayer identification
to act on behalf of the business. The fact that an individual’s
number as shown on your Official Letter of Notification, along
name is signed on the certification will be prima facie evidence
with the company name and address.
that the individual is authorized to sign and certify this
Primary contact information — Enter the name, telephone
information.
number and fax number of your primary contact as designated in
Note: If you are a required participant in the EFT program
your enrollment information.
for more than one tax, exemption from participation in the
The following is a step-by-step instruction for completing this
program for one tax type does not release you from mandatory
form using fictitious figures from the XYZ Corporation.
participation in the program for any other tax for which you may
qualify. You must demonstrate hardship for each individual tax by
Period
Articles 12-A and 13-A tax amount
submitting the applicable exemption form.
9/06 - 2/07
$1,500,000
The completed form should be mailed to:
3/06 - 8/06
3,000,000
NYS TAX DEPARTMENT
9/05 - 2/06
5,700,000
PROMPTAX — PBT
Line a
Enter the total Article 12-A and 13-A taxes from the
W A HARRIMAN CAMPUS
most recent six-month period and the beginning and
ALBANY NY 12227
ending month/year for that period.
Need help?
Example: For the period 9/06 through 2/07, the
figure is $1,500,000.
Visit our Web site at
Line b
Enter the total Article 12-A and 13-A taxes for the
(for information, forms, and online services)
same six-month period as in line a for the prior year
Telephone assistance
and the beginning and ending month/year for that
period.
PrompTax Customer Service Center:
(518) 457-2332
Example: For the period 9/05 through 2/06, the
figure is $5,700,000.
Line c
Enter the amount derived by dividing line a by
line b. This amount must be less than 50% (0.5) in
order to satisfy the first of two statutory hardship
exemption criteria and must be calculated to three
decimal places.
Example: The line a figure of $1,500,000 is divided
by the line b figure of $5,700,000, which equals
.263.
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