New York State Department of Taxation and Finance
                                                                                                                                                           MT-170
                                       Waste Tire Management Fee                                                                                                     (8/11)

                                       Quarterly Return (with instructions)
                                                                                             If you file separate sales tax returns for each location, file a separate waste 
General information                                                                          tire management fee return for those same locations.
Tire sellers must collect a fee of $2.50 on each new tire sold within                        The Tax Law requires that you keep a copy of your completed return for at 
New York State. The waste tire management fee does not apply to sales of                     least three years.
used or recapped tires, mail order sales, or sales for resale. The sellers are 
entitled to retain a statutory allowance of $.25 per tire from fees collected.               Is this your final return? — If you are filing the final return for this 
The Tax Department is responsible for administering the fee, which is                        fee for this business at this/these location(s), mark an  Xin the Final return 
imposed by Environmental Conservation Law section 27‑1913.                                   box on the front of the return.
The waste tire fee applies to new tires sold for use on nearly all                           Is this an amended return? — If you are filing an amended return 
self‑propelled or towed vehicles that could be registered for any reason.               for any purpose, mark an  Xin the        Amended return box on the front of the 
The fee also applies to new tires sold with a new or used vehicle, including            return, enter the ending date of the quarter, and the corrected information 
spare tires, whether they are full‑size or for emergency use only.                      in the area provided, and attach an explanation. If you have overpaid, the 
                                                                                        Tax Department will mail you a refund. If you have any questions, see Need 
For more detailed information about which sales of tires are subject to this            help?.
fee, please refer to TSB‑M‑04(2)M, Waste Tire Management Fee Changes 
for 2004.                                                                                    Did you sell tires during this quarter? — If you did not sell any 
                                                                                        tires during this quarter, mark an Xin the box on the front of the return and 
Who must file — If you sell tires, including recapped tires, mail order                 sign and date your return. If you sold tires, but did not sell any tires that you 
sales, and tires sold for resale, you must file a return even when you had              were required to collect the fee on, see the instructions for line 1.
no sales of tires for which you were required to collect the waste tire 
management fee during the quarter.                                                           Line instructions
When to file — The quarterly reporting periods and return due dates                          Line 1 — Enter the number of tires sold during the quarterly period that 
are as follows:                                                                              were subject to the waste tire management fee. See TSB‑M‑04(2)M, Waste 
                                                                                             Tire Management Fee Changes for 2004, for information about which tires 
Quarterly period                                                    Due date for             are subject to the fee.
                                                                    filing return
                                                                                             If you did not sell any tires for which you were required to collect the fee 
December 1 through February 28 (29) ..............................  March 31                 during the quarterly period, enter 0on lines 1, 3, 4, 5, and 6 and sign the 
March 1 through May 31 ...................................................  June 30          return.
June 1 through August 31 .................................................  September 30
September 1 through November 30 ..................................  December 31              Line 2 — This preprinted amount represents the portion of the fee per tire 
                                                                                             which is payable to the department after deducting the statutory allowance 
Where to file — Mail to:        NYS TAX DEPARTMENT                                           the seller is entitled to retain.
                                WASTE TIRE MANAGEMENT FEE                                    Line 3 — Multiply the number of tires entered on line 1 by the fee due of 
                                PO BOX 4100                                                  $2.25 per tire.
                                BINGHAMTON NY 13902-4100
                                                                                             Line 4 — If penalties and interest apply (see below), enter the appropriate 
Private delivery services — To use a private delivery service, see                           amount.
Publication 55, Designated Private Delivery Services.
                                                                                             Signature
Completing your return                                                                       The return must be certified by the president, vice president, treasurer, 
                                                                                             assistant treasurer, chief accounting officer, or other officer authorized by 
Is this return for multiple locations? — If you are a tire retailer                          the taxpayer corporation.
with more than one location in the state, and you file a combined sales tax 
return for all locations, file a combined waste tire management fee return for               The return of an association, publicly traded partnership, or business 
those same locations. Mark an  Xin the Multiple locations box on the return                  conducted by a trustee or trustees must be signed by a person authorized 
and indicate the number of locations covered by this report. Please type or                  to act for the association, publicly traded partnership, or business.
print (use black ink only; no red or other color ink or pencils please).

                                       Print this return 2-sided, complete front and back, and detach here

                                       New York State Department of Taxation and Finance
                MT-170                                                                                                                          Quarterly period ending
                            (8/11)     Waste Tire Management Fee
                                       Quarterly Return
                                       Read instructions before completing return                         1. Number of tires sold 
                                                                                                              subject to fee ...............   1.
 Sales tax                                                                                                2. Fee due per tire ($2.50 
   identification number ....................                                                               fee – $.25 allowance)  .......  2. $                  2 25
 Business name                                                                                            3. Net amount of fees due
                                                                                                            (line 1 x line 2)  ..................  3.
 Address (number and street or rural route)                                                               4. Penalties and interest
                                                                                                            (see instructions) ...............  4.
 City, village, or post office                  State                               ZIP code              5. Total amount due
                                                                                                            (add lines 3 and 4) ............  5.
 This return is for(mark an Xinone)  :                                                                    6. Amount remitted with this
        Single location              Multiple locations (enter number):                                     return ........................... 6.
 Mark an  Xin the box if:                                                                                 If line 5 and line 6 arenot the same amount, attach an 
      Final return        Amended return        Did not sell any tires in this quarter                    explanation.
                                                                                    Complete back

MT-170 (8/11) (back)
If an outside individual or firm prepared the return, all applicable entries    You may not be liable for penalties if your failure to file or remit the fees is 
in the paid preparer section must be completed, including identification        due to reasonable cause and not due to willful neglect. If you think you are 
numbers (see Paid preparer identification numbers). Failure to sign the         not liable for these additional charges, attach a statement to your return 
return will delay the processing of any refunds and may result in penalties.    explaining the delay in filing, payment, or both (Tax Law section 1085).
Paid preparer identification numbers—    New York State Tax Law requires        Note: You may compute your penalty and interest by accessing our Web 
certain paid tax return preparers and facilitators of refund anticipation loans site,or you may call and we will compute the penalty and interest for you 
(RALs) and refund anticipation checks (RACs) to register electronically with    (see Need help? ).
the Tax Department. When completing this section, you must enter your 
New York tax preparer registration identification number (NYTPRIN) if you       • If you understate the net amount of fees due — If the net amount of 
are required to have one. (Information on the New York State Tax Preparer         fees you report is understated by 10% or $5,000, whichever is greater, 
Registration Program is available on our Web site (see Need help?  ).)In          you must pay a penalty of 10% of the amount of understated fees. 
addition, you must enter your federal preparer tax identification number          You may not be liable for this penalty if (1) there is or was substantial 
(PTIN) if you have one; if not, you must enter your social security number        authority for your calculation of the net amount, (2) there is adequate 
(SSN). (PTIN information is available at www.irs.gov.)                            disclosure on the return or in an attached statement, or (3) there was 
                                                                                  reasonable cause for the understatement (see Tax Law section 1085(k)).
Attach check or money order payable to: Commissioner of Taxation and 
Finance
On your check, write Form MT‑170, your sales tax identification number, and the Need help?
period for which you are reporting.
                                                                                         Visit our Web site at www.tax.ny.gov
Fee for payments returned by banks                                                       •  get information and manage your taxes online
The law allows the Tax Department to charge a $50 fee when a check,                      •  check for new online services and features
money order, or electronic payment is returned by a bank for nonpayment. 
However, if an electronic payment is returned as a result of an error by                Business Tax Information Center:             (518) 457-5342
the bank or the department, the department won’t charge the fee. If your                To order forms and publications:             (518) 457-5431
payment is returned, we will send a separate bill for $50 for each return or 
other tax document associated with the returned payment.                                 
                                                                                        Text Telephone (TTY) Hotline
Penalties and interest                                                                      (for persons with hearing and
Interest                                                                                  speech disabilities using a TTY):          (518) 485-5082
•  If you pay after the due date — If you do not pay the entire net amount 
of fees due (line 3) on or before the due date, you must pay interest on        Privacy notification
the amount of the underpayment from the due date of the return to the           The Commissioner of Taxation and Finance may collect and maintain 
date full payment is made.                                                      personal information pursuant to the New York State Tax Law, including but 
Penalties                                                                       not limited to, sections 5‑a, 171, 171‑a, 287, 308, 429, 475, 505, 697, 1096, 
•  If you file and pay after the due date — Compute additional charges          1142, and 1415 of that Law; and may require disclosure of social security 
for late filing and late payment on the net amount of fees due, minus any       numbers pursuant to 42 USC 405(c)(2)(C)(i).
payment made on or before the due date.                                         This information will be used to determine and administer tax liabilities 
  A. If you do not file a return when due, add to the net fees 5% per           and, when authorized by law, for certain tax offset and exchange of tax 
     month up to 25% (Tax Law section 1085(a)(1)(A)).                           information programs as well as for any other lawful purpose.
  B. If you do not file a return within 60 days of the due date, the            Information concerning quarterly wages paid to employees is provided 
     additional charge in item A above cannot be less than the smaller          to certain state agencies for purposes of fraud prevention, support 
     of $100 or 100% of the net fees required to be shown on the return         enforcement, evaluation of the effectiveness of certain employment and 
     (Tax Law section 1085 (a)(1)(B)).                                          training programs and other purposes authorized by law.
  C. If you do not pay the net fees shown on a return when due,                 Failure to provide the required information may subject you to civil or 
     add to the net fees ½% per month up to a total of 25% (Tax Law             criminal penalties, or both, under the Tax Law.
     section 1085 (a)(2)).
  D. The total of the additional charges in items A and C may not               This information is maintained by the Manager of Document Management, 
     exceed 5% for any one month, except as provided for in item B              NYS Tax Department, W A Harriman Campus, Albany NY 12227; 
     above (Tax Law section 1085 (a)).                                          telephone (518) 457‑5181.

MT-170 (8/11) (back)
I hereby certify that this return is true and correct. I make these statements with the knowledge that knowingly making a false or fraudulent 
statement on this document is a misdemeanor under section 210.45 of the Penal Law. 
                  Signature of authorized person                                  Official title
Authorized
    person        E‑mail 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 document         Address                                 City           State       ZIP code
    use
    only     E‑mail address of individual preparing this document                                  Preparer’s NYTPRIN          Date
(see instr.)

                                                     Mail to:     NYS TAX DEPARTMENT
                                                                  WASTE TIRE MANAGEMENT FEE
                                                                  PO BOX 4100
                                                                  BINGHAMTON NY 13902-4100