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Page 2 of 2 FT-943 (5/23)
Part 3 – Summary of motor fuel and diesel motor fuel purchases
Retail vendors must report motor fuel purchases (if not registered as a service station in Part 6 of Form FT-945/1045, Prepaid Sales Tax on Motor
motor fuel distributor) and highway diesel motor fuel purchases (if not Fuel/Diesel Motor Fuel Return, enter self in column A and complete the
registered as a diesel motor fuel or kero-jet fuel distributor). Complete information requested in columns C and D for that fuel.
columns A through D for fuel purchased in New York State during the
quarter. For diesel motor fuel purchases – Enter the name and identification
number of the supplier from whom the fuel was purchased as it appears on
Column A either Form FT-1000, Certificate of Prepayment or Payment of Taxes on
Diesel Motor Fuel, or on another document given to you certifying that the
For motor fuel purchases – Enter the name and identification number taxes were paid. List all suppliers from whom you purchase diesel motor
of the supplier from whom the fuel was purchased as it appears on either fuel.
Form FT-935, Certification of Taxes Paid on Motor Fuel (Prepayment of
Sales Tax and Payment of the Motor Fuel Tax and the Petroleum Business Column C –Indicate the type of fuel purchased by entering U(regular
Tax), or on another document given to you certifying that the taxes were unleaded), M(mid-grade unleaded), (premiumP unleaded), D (diesel), or
paid. List all suppliers from whom you purchase motor fuel. K (kero-jet).
If you are an MCTD or non-MCTD motor fuel wholesaler, and reported a Column D – Enter the total number of gallons for each type of fuel
transfer of motor fuel from your non-retail marketing locations to your retail purchased during the quarter from that supplier.
A – Name and ID number of supplier B – Address of supplier C – Type D – Total gallons
(street, city, state, and ZIP code) of fuel purchased
(Name)
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(ID number)
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Attach additional sheets, if necessary, to list all suppliers for the reporting period.
Signature of authorized person Official title
Authorized
person Email address of authorized person Telephone number Date
( )
Paid Firm’s name (or yours if self-employed) Firm’s EIN Preparer’s PTIN or SSN
preparer Signature of individual preparing this report Address City State ZIP code
use
only Email address of individual preparing this report Telephone number Preparer’s NYTPRIN NYTPRIN Date
(see instr.) ( ) excl. code
Signature Where to file
If you are a sole proprietor, you must sign the report and print your title, Mail your report to: NYS Tax Department, Petroleum Tracking Unit,
email address, telephone number, and date. PO Box 15197, Albany NY 12212-5197.
If you are filing this report for a corporation, partnership, or other type of Private delivery service – If you are using a private delivery service, see
entity, an officer, employee, or partner must sign the report on behalf of the Publication 55, Designated Private Delivery Services.
business, and print his or her title, email address, telephone number, and
date.
If you do not prepare the report yourself, sign, date, and provide the Need help?
requested taxpayer information. The preparer must also print his, her,
or the firm’s name, sign the report, and provide the requested preparer Visit our website at www.tax.ny.gov
information. Also see Paid preparer’s responsibilities below.
• get information and manage your taxes online
Paid preparer’s responsibilities – Under the law, all paid preparers must
sign and complete the paid preparer section of the form. Paid preparers • check for new online services and features
may be subject to civil and/or criminal sanctions if they fail to complete this
section in full. Telephone assistance
When completing this section, enter your New York tax preparer registration Miscellaneous Tax Information Center: 518-457-5735
identification number (NYTPRIN) if you are required to have one. If you are not
required to have a NYTPRIN, enter in the NYTPRIN excl. code box one of the To order forms and publications: 518-457-5431
specified 2-digit codes listed below that indicates why you are exempt from the Text Telephone (TTY) or TDD Dial 7-1-1 for the
registration requirement. Youmust enter a NYTPRIN oran exclusion code. equipment users New York Relay Service
Also, you must enter your federal preparer tax identification number (PTIN) if
you have one; if not, you must enter your Social Security number.
Privacy notification – New York State Law requires all government
Code Exemption type Code Exemption type agencies that maintain a system of records to provide notification of the
01 Attorney 02 Employee of attorney legal authority for any request for personal information, the principal
purpose(s) for which the information is to be collected, and where it will be
03 CPA 04 Employee of CPA maintained. To view this information, visit our website, or, if you do not have
Internet access, call and request Publication 54, Privacy Notification. See
05 PA (Public Accountant) 06 Employee of PA Need help? for the Web address and telephone number.
07 Enrolled agent 08 Employee of enrolled agent
09 Volunteer tax preparer 10 Employee of business
preparing that business’ return
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