Form Tr-692 - Promptax - Motor Fuel And Petroleum Business Taxes Certified Check Transmittal Form

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Department of Taxation and Finance
TR-692
PrompTax – Motor Fuel and Petroleum
(7/15)
Business Taxes Certified Check Transmittal Form
Taxpayer ID number
Business name
Street address
City
State
ZIP code
1)
Enter the ending date of the tax period for which the motor fuel taxes and
/
/
petroleum business tax (Articles 12-A and 13-A) payment is enclosed ...................
(mm)
(dd)
(yy)
2)
Enter amount due for motor fuel taxes (Article 12-A liabilities) ................................ $
.
3)
Enter amount due for petroleum business tax (Article 13-A liabilities) ..................... $
.
4)
Enter amount of certified check enclosed (dollars and cents) ................................. $
.
This amount should equal the sum of liabilities from lines 2 and 3.
Instructions
Use this form only for transmitting certified check payments for motor fuel and petroleum business taxes as required under
the electronic funds transfer program.
Type or print this form. Be sure to complete all fields.
Keep a copy of this form for your records.
When you file Form PT‑100, Petroleum Business Tax Return, for the period indicated, include on the EFT or certified
check line of the return the amount of this payment.
Send this form with your certified check to:
NYS TAX DEPARTMENT
PSSB-PBT PROMPTAX
W A HARRIMAN CAMPUS
ALBANY NY 12227-0863
To be considered timely, your certified check accompanied by this form must be postmarked no later than one business
day following the 22nd of the month.
Need help?
Visit our Web site at
(for information, forms, and online services)
Telephone assistance
For internal use only
Period designator
PrompTax Customer Service Center:
(518) 457-2332

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