Form Dtf-686-Att - New York Reportable Transaction Disclosure Statement And Request For A Determination - 2015

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DTF-686-ATT
Department of Taxation and Finance
New York Reportable Transaction
Disclosure Statement and
Request for a Determination
All filers must enter tax period:
beginning
ending
Name(s) as shown on return
Taxpayer identification number shown on page 1 of your tax
return
Spouse’s identification number
Spouse’s name
(for personal income tax, if applicable)
(if applicable)
Mailing address
City, village, town, or post office
State
ZIP code
Taxpayer’s e-mail address
A
Mark an X in the box if a protective disclosure .............................................................................................................
Mark an X in the box if requesting a determination ......................................................................................................
B
Initial year participated in
Name of New York reportable transaction
1b
1a
(see instructions)
transaction
(yyyy; see instructions)
2 Identify the type of New York reportable transaction. Mark an X in the boxes that apply
.
(see instructions)
b
New York confidential transaction
a
New York listed transaction
c
New York transaction with contractual protection
3 If the transaction is a listed transaction, or substantially similar to a listed transaction, identify here
.
(see instructions)
4 If you participated in the transaction through another entity, such as a partnership, an S corporation, or a foreign corporation,
provide the information below for the entity(ies)
.
(see instr.)
a Name ......................................................................
b Type of entity ...........................................................
c Form number of New York State tax return filed .....
d Employer identification number (EIN) .....................
5 Enter below the name and address of each person to whom you paid a fee with regard to the transaction if that person promoted,
solicited, or recommended your participation in the transaction, or provided tax advice related to the transaction. Attach additional
sheets if necessary.
Name
Identifying number
(if known)
Mailing address
Apartment number
Fee paid
(number and street or rural route)
City, village, or post office
State
ZIP code
687001150094

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