Form Au-212 - New York State Pari-Mutuel Betting Tax Return

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AU-212
New York Department of Taxation and Finance
New York State Pari-Mutuel Betting Tax Return
(11/11)
Under Sections 236, 238, 318, 418, and 527 of the Racing Pari-Mutuel Wagering and Breeding Law
Name of organization
Federal employer identification number (EIN)
Street address
City
State
ZIP code
Reporting period: from
to
Return type:
Thoroughbred
Harness
OTB
1 Total amount of taxable bets for the period ...................................................................................
1
2 Gross New York State pari-mutuel tax ....................................
2
3 Total New York State share of breakage .................................
3
4 Total New York State pari-mutuel tax and breakage
..........................................
4
(add lines 2 and 3)
Adjustments/miscellaneous
5 Breeders Fund credits
5
Period: from
to
.......
6 Simulcast credits
Period: from
to
.......
6
7 OTB pari-mutuel tax credit
Period: from
to
.......
7
8 Total credits
8
....................................................................................................
(add lines 5, 6, and 7)
9 Subtract line 8 from line 4 ..............................................................................................................
9
10 Miscellaneous adjustments
Explain:
10
11 Total tax
...................................................................................... 11
(add or subtract line 10 from line 9)
Date
Signature of authorized person
Title
Date
Signature of individual or name of firm preparing this return
Preparer’s address
Mail this original return to: New York State Tax Department, T-DAB – Pari-Mutuel Tax, W A Harriman Campus, Albany NY 12227.

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