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Section 5 — Purchase information

Value

1 Purchase price

a. Amount of cash payment .......................................................................................... 1a $

b. Balance of payments assumed ................................................................................ 1b $

c. Value of property given, traded, or swapped, or services performed instead of cash payment ... 1c $

........................................................................................................ 1d $

d. Purchase price

(total of lines 1a, 1b, and 1c)

2 Was this transaction the purchase of a motor vehicle from

your spouse, parent, child, stepparent, or stepchild?

Yes

(enter 0 on line 4; no tax is due)

(continue to line 3)

3 Tax rate

.................................................................................................................................

(enter as a decimal)

4 Sales tax due

..................................................................................................................

(multiply line 1d by line 3)

5 Is the amount on line 1d lower than fair market value?

Yes

(seller/donor must complete Section 6)

(sign certification below)

* Tax rate note: For a motor vehicle, trailer, or boat, use the tax rate of the new owner's place of residence. If the purchaser is a resident in two or more counties in

the state, use the rate in effect in the place where the motor vehicle, trailer, or boat will be principally used or garaged. If the new owner is a business, use the tax

rate of the place of business. If the business has locations in two or more counties in the state, use the rate in effect in the place where the motor vehicle, trailer, or

boat will be principally used or garaged. For an ATV or snowmobile, use the higher rate of where the new owner took delivery, or where the vehicle is stored or used

if new owner has a residence in storage/use locality.

Purchaser certification —

I certify that the above statements are true and complete; and I make these statements with

the knowledge that willfully issuing a false or fraudulent statement with the intent to evade tax is a misdemeanor under Tax Law

section 1817(b), and Penal Law section 210.45, punishable by a fine up to $10,000 for an individual and $20,000 for a corporation.

Signature

Date

If this form is submitted by someone other than the new owner/lessee, please provide the following:

Name/business name

Social security number, TIN, or federal EIN

Address

Section 6 — Affidavit of sale or gift of a motor vehicle, trailer, ATV, vessel (boat), or snowmobile

The seller or donor must complete if:

• the motor vehicle is a gift to a person other than a spouse, parent, child, stepparent, or stepchild

• the motor vehicle is sold below fair market value to a person other than a spouse, parent, child, stepparent, or stepchild

• the trailer, ATV, boat, or snowmobile is a gift

• the trailer, ATV, boat, or snowmobile is sold below fair market value

6 Cash payment received .................................................................................................................................... 6

7 If, as a condition for the sale or gift of the vehicle or boat, the purchaser/recipient did any of the following in addition to, or in

lieu of, a cash payment, please mark an X in the appropriate box and indicate the value of the service or goods you received.

Value

a Performed any service .....................................................................................................

Yes

7a $

b Assumed any debt ...........................................................................................................

Yes

7b $

7c $

c Traded/swapped a vehicle or other property ...................................................................

Yes

............................................................................................. 7d $

d Total selling price

(total of lines 6, 7a, 7b and 7c)

8 Complete only if a corporation or business is the seller/donor

a Was or is the purchaser/recipient an employee, officer, or stockholder of the company/corporation? ......................

Yes

b Was the transaction part of any terms of employment, employment contract, or termination agreement? ...............

Yes

9 If you answered Yes to any part of line 7 or line 8, please provide an explanation:

Seller/Donor certification —

I have reviewed the information on Form DTF-802 and I certify that the statements are true and complete.

I make these statements with the knowledge that willfully issuing a false or fraudulent statement with the intent to evade tax is a misdemeanor under

Tax Law section 1817(b) and Penal Law section 210.45 punishable by a fine up to $10,000 for an individual and $20,000 for a corporation.

Signature

Name (printed or typed)

Date

Privacy notification —

The Commissioner of Taxation and Finance may collect and maintain personal information

Information concerning quarterly wages paid to employees is provided to certain state agencies for purposes of fraud

pursuant to the New York State Tax Law, including but not limited to, sections 5-a, 171, 171-a, 287, 308, 429, 475,

prevention, support enforcement, evaluation of the effectiveness of certain employment and training programs and other

505, 697, 1096, 1142, and 1415 of that Law; and may require disclosure of social security numbers pursuant to

purposes authorized by law.

42 USC 405(c)(2)(C)(i).

Failure to provide the required information may subject you to civil or criminal penalties, or both, under the Tax Law.

This information will be used to determine and administer tax liabilities and, when authorized by law, for certain tax offset

This information is maintained by the Manager of Document Management, NYS Tax Department, W A Harriman Campus,

and exchange of tax information programs as well as for any other lawful purpose.

Albany NY 12227; telephone (518) 457-5181.

DTF-802 (1/11) (back)

Form Dtf-802 - Statement Of Transaction-Sale Or Gift Of Motor Vehicle, Trailer, All-Terrain Vehicle (Atv), Vessel (Boat), Or Snowmobile Page 2

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