Dtf-719-Mn - Renewal Application For Registration Of Retail Dealers And Vending Machines For Sales Of Cigarettes And Tobacco Products
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4Department of Taxation and Finance
DTF-719-MN
Renewal Application for Registration of
(6/15)
Retail Dealers and Vending Machines for
C16
Sales of Cigarettes and Tobacco Products
Use this form to renew registration for all or any portion of the period from
January 1, 2016, through December 31, 2016.
Legal name of business
Date
DBA (doing business as)/trade name
Sales tax vendor identification number
Mailing address; c/o name
Number and street
City, state, ZIP code
Read the instructions (Form DTF-719-I) before completing this form.
Use this form to renew the registration for retail dealer certificates and vending machine certificates only if you are
currently registered for 2015. If registering for the first time, use Form DTF-716, Application for Registration of Retail Dealers and
Vending Machines for Sales of Cigarettes and Tobacco Products. (See General information and When to file on Form DTF-719-I.)
A
C
D
B
Number of
Amount due
Code
Cost of each
certificates
(A x B)
1. Certificates of registration for retail operations
$300
$
7030
(from Part A; see instructions) . . . . . . . . . . . . . . . . . . . . . . . . .
2. Vending machine registration certificates
$100
$
7040
(from Part B; see instructions) . . . . . . . . . . . . . . . . . . . . . . . . .
$
3.
Total amount due (add lines 1 and 2, column C) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Note: Vending machine registration certificates and certificates of registration for the period
For office use only
January 1, 2016, through December 31, 2016, will not be issued before December 1, 2015.
– Attach check or money order for the amount on line 3 payable to : New York State Sales Tax.
– Write your sales tax vendor identification number, Form DTF-719-MN, and the year for which
you are registering on the front of your check or money order.
– Mail your application and remittance on or before September 21, 2015.
– Do not mail this application in the envelope with your sales tax return.
Signature of applicant
Title
Mail to:
NYS TAX DEPARTMENT
Daytime telephone number
Date
PO BOX 15175
(
)
ALBANY NY 12212-5175
72000106150094
DTF-719-MN (6/15)
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