Fillable Form Dtf-350 - Group Affidavit printable pdf download

DTF-350

New York State Department of Taxation and Finance

Group Affidavit

(2/10)

Attach to: Form TR-99, IT-203-GR, IT-203-S, or IT-203-TM; or

MTA-599 or MTA-505

State of

Special NYS identification number

( see instructions )

County of

being duly sworn, states:

I reside at

in the city/town/village/borough, etc.,

, State of

1. Partnerships or S corporations - I am a partner in the firm of

or a shareholder of

, which is described in the attached application, Form TR-99, or Form MTA-599

or the attached group return, Form IT-203-GR, Form IT-203-S, or Form MTA-505, whichever is applicable, for the tax year ending

; or

the

day of

, 20

2. Athletic teams - I am associated with the group

, which is described in the attached

application, Form TR-99, or the attached group return, Form IT-203-TM, whichever is applicable, for the tax year ending

the

day of

, 20

I have been duly and properly designated and authorized under the laws of the State of New York and the laws of any other state, if

applicable, to act as agent, for the purposes described herein, for each and every New York:

resident or nonresident partner subject to the

nonresident

partner

shareholder

team member

metropolitan commuter transportation mobility tax

(hereinafter referred to as group members) named, listed or otherwise described in the attached application or group return, and any

attachment, schedule, or list appended thereto, which application or group return I am signing and filing with the New York State

Department of Taxation and Finance on behalf of the group members.

As agent, I am authorized to receive confidential information and to perform any and all acts that each of the group members can

perform with respect to making, executing, and filing this application or return. By reason of this delegation of authority from each of

the group members, I am acting as a common partner or group representative (hereinafter referred to as group agent ) pursuant to

20 NYCRR section 151.17 of the Regulations of the New York Commissioner of Taxation and Finance, and Article 23 of the Tax Law.

I am submitting this affidavit with the understanding that the New York State Department of Taxation and Finance will rely upon it;

and I am aware that offering a false instrument for filing is a class A misdemeanor or a class E felony under the New York State Penal

Law; and supplying false information, filing a false return and aiding or assisting in the giving of fraudulent returns, reports, statements,

or other documents constitute misdemeanors and felonies under Article 37 of the New York State Tax Law.

Sworn to before me this

Signature

day of

, 20

Print name beneath signature

(

)

Daytime phone number

Notary Public

My commission expires

E-mail address

3501100094

Please file this original scannable form

with the Tax Department.

3501100094

Form Dtf-350 - Group Affidavit

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