Form Ft-959 - Special Fuel Tax Return For Unregistered Distributors (Page 2 of 2) in pdf

Page 2 of 2 FT-959 (11/12)

Third-party designee

If you want to authorize another person (third-party designee) to discuss

this tax return with the NYS Tax Department, mark an X in the Yes box

in the Third-party designee area of your return. Also print the designee’s

name, phone number, and any five-digit number the designee chooses

as his or her personal identification number (PIN). You cannot change

the PIN. If you do not want to authorize another person, mark an X in

the No box.

If you mark the Yes box, you are authorizing the Tax Department to

discuss with the designee any questions that may arise during the

processing of your return. You are also authorizing the designee to:

• give the Tax Department any information that is missing from your

return;

• call the Tax Department for information about the processing of your

return or the status of your refund or payment(s); and

• respond to certain Tax Department notices that you shared with the

designee about math errors, offsets, and return preparation. The

notices will not be sent to the designee.

You are not authorizing the designee to receive your refund, bind you

to anything (including any additional tax liability), or otherwise represent

you before the Tax Department. If you want the designee to perform

those services for you, you must file Form POA-1, Power of Attorney,

making that designation with the Tax Department. Copies of statutory

tax notices or documents (such as a Notice of Deficiency) will only be

sent to your designee if you file Form POA-1.

Certification

The return must be signed and dated by the owner (if an individual);

a partner (if a partnership); or by the president, treasurer, chief

accounting officer, or any other person authorized to act on behalf of

the corporation (if a corporation). The fact that an individual’s name

is signed on the certification shall be prima facie evidence that the

individual is authorized to sign and certify the return on behalf of the

business.

Privacy notification

The Commissioner of Taxation and Finance may collect and maintain

personal information pursuant to the New York State Tax Law, including

but not limited to, sections 5-a, 171, 171-a, 287, 308, 429, 475, 505,

697, 1096, 1142, and 1415 of that Law; and may require disclosure of

social security numbers pursuant to 42 USC 405(c)(2)(C)(i).

This information will be used to determine and administer tax liabilities

and, when authorized by law, for certain tax offset and exchange of tax

information programs as well as for any other lawful purpose.

Information concerning quarterly wages paid to employees is provided

to certain state agencies for purposes of fraud prevention, support

enforcement, evaluation of the effectiveness of certain employment and

training programs and other purposes authorized by law.

Failure to provide the required information may subject you to civil or

criminal penalties, or both, under the Tax Law.

This information is maintained by the Manager of Document

Management, NYS Tax Department, W A Harriman Campus, Albany NY

12227; telephone (518) 457-5181.

Need help?

Internet access:

(for information, forms, and publications)

Miscellaneous Tax Information Center:

(518) 457-5735

To order forms and publications:

(518) 457-5431

Text Telephone (TTY) Hotline

(for persons with hearing and

speech disabilities using a TTY):

(518) 485-5082

Form Ft-959 - Special Fuel Tax Return For Unregistered Distributors Page 2

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