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Page 2 of 2 AU-12-I (8/18)
of Eligibility (issued by ESD) determines which worksheet you need to • If the invoices and credit memoranda to be submitted are voluminous,
include. submit a schedule or a summary in table form. The schedule or
• Form AU-12.1, if you were certified by ESD before April 1, 2005 summary should contain all pertinent information concerning these
documents, such as invoice number, date of invoice, name of
• Form AU-12.2, if you were certified by ESD on or after April 1, 2005, purchaser or supplier, item sold or purchased, amount of invoice
and before April 1, 2009 excluding tax, amount of tax billed, taxing jurisdiction where sale
• Form AU-12.3, if you were certified by ESD on or after April 1, 2009 or purchase was made, and the reason the applicant is entitled to
a credit or refund. We may request documentation to verify any
If you were certified before April 1, 2009,complete the employment test schedule or summary that you submit.
using your base period information from your application for QEZE sales
tax certification filed with the Tax Department (Form DTF-80, Application • The supporting documents should include the vendor’s name and
for a Qualified Empire Zone Enterprise (QEZE) Sales Tax Certification; address. If they don’t, or if the transaction took place somewhere
Form DTF-82, Application for a Qualified Empire Zone Enterprise other than the vendor’s address, you must:
(QEZE) Sales Tax Certification – For businesses certified by Empire – include the vendor’s name and location;
State Development before August 1, 2002; Form DTF-83, Application for – include the location where the transaction took place (generally,
a Qualified Empire Zone Enterprise (QEZE) Sales Tax Certification – For where you took title or possession); and
businesses certified by Empire State Development on or after August 1, – include the invoices showing the tax you paid.
2002, and before April 1, 2005; or Form DTF-84, Application for a
Qualified Empire Zone Enterprise (QEZE) Sales Tax Certification – For
businesses certified by Empire State Development on or after April 1, Representative
2005, and before April 1, 2009). If an outside individual or firm prepared the application (not the applicant
or the owner, partner or an officer of the business listed as the applicant)
If you have more than one EZ location, use the effective date from your the name and address should be included under Representative’s
first (earliest) Certificate of Eligibility to determine which worksheet you name and Representative’s mailing address. The representative’s
need to file. signature and the identification number of the firm should be included
You must complete and pass the employment test using your under Representative’s signature and Representative’s ID number.
employment numbers for the tax year ending before the period covered The representative must file a properly completed Form POA-1, Power
by this application to qualify for the credit or refund being claimed. Once of Attorney, authorizing him/her to act on the applicant’s behalf and to
you have completed the employment test worksheet for a tax year, receive information pertaining to the application for credit or refund.
attach a copy of that worksheet to any subsequent claim for credit or Form POA-1 is available on our Web site (see Need help?).
refund to which that employment test applies.
If your credit or refund claim covers periods from more than one tax year, When to file your application
you must complete and attach employment test worksheets for each tax Generally, you must submit your application within three years from the
year required. date the tax was payable to the Tax Department, or two years from the
date the tax was paid, whichever is later. You may file this form only
Example: A business was certified by ESD with an effective date of once each sales tax quarter.
February 15, 2008, on its Certificate of Eligibility. The business applied
for and received QEZE sales tax certification from the Tax Department Where to file your application
effective October 1, 2008. The business files taxes on a calendar year
basis. Mail your completed application and all required substantiation and
documentation to:
At the end of December 2008, the business completed the employment test NYS TAX DEPARTMENT
for the 2008 tax year (January through December 2008) and determined that TDAB – SALES TAX REFUNDS
it qualifies for QEZE sales tax benefits for 2009. W A HARRIMAN CAMPUS
ALBANY NY 12227-9364
At the end of December 2009, the business completed the employment test
for the 2009 tax year (January through December 2009) and determined that If not using U.S. Mail, see Publication 55, Designated Private Delivery
it qualifies for QEZE sales tax benefits for 2010. Services.
In March 2010, the business files Form AU-12 to claim a refund of
tax paid on qualifying purchases made during September through
December 2009 and for January through February 2010. When Need help?
filing Form AU-12 to claim the refund, it must complete and attach
Form AU-12.2 for the 2008 tax year to support its claim for a refund Visit our website at www.tax.ny.gov
for the September through December 2009 period, and Form AU-12.2 • get information and manage your taxes online
for the 2009 tax year to support its claim for a refund for the January
through February 2010 period. • check for new online services and features
In June 2010, the business files Form AU-12 to claim a refund of tax Telephone assistance
paid on qualifying purchases made during March through May 2010.
When filing Form AU-12 to claim the refund, it must attach a copy of its Sales Tax Information Center: 518-485-2889
Form AU-12.2 for the 2009 tax year to support the refund claimed.
To order forms and publications: 518-457-5431
Documentation Text Telephone (TTY) or TDD Dial 7-1-1 for the
• Explain the basis for the credit or refund claim in detail and send equipment users New York Relay Service
legible copies of all supporting documents (for example: invoices,
receipts, proof of payment of tax, etc.).
• Your documents must be in a format that allows the Tax Department Privacy notification
to determine the correct jurisdiction and amount for each credit New York State Law requires all government agencies that maintain a
or refund claimed. Cash receipts, register tapes, or other forms of system of records to provide notification of the legal authority for any
receipts or invoices that don’t identify the purchaser may not be request for personal information, the principal purpose(s) for which the
accepted. information is to be collected, and where it will be maintained. To view
• Your documents must contain the address of the business receiving this information, visit our website, or, if you do not have Internet access,
the property or services. call and request Publication 54, Privacy Notification. See Need help? for
• If your form is incomplete, or if you don’t provide necessary supporting the Web address and telephone number.
documents, we may deny your application.
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