New York State Department of Taxation and Finance
                New York State and Local Sales and Use Tax                                                                 ST‑112
                                                                                                                                                           (4/11)
                Annual Application for a Materialman to Remit
                Sales Tax Under the Pay‑When‑Paid Option
                                For period ending May 31,                           (enter year) 
 Legal name                                                                                      Sales tax vendor identification number

 DBA or trade name (if different from legal name above)                                          Telephone number
                                                                                                 (      )
 Street address

 City                                                                               State        ZIP code

Qualifying materialmen may postpone remitting the sales tax until they receive payment (pay‑when‑paid) on qualifying 
sales to contractors. A qualifying sale is a sale of building materials or services performed on such materials to a 
contractor, subcontractor, or repairman for the improvement of real property, provided the sale is made on credit 
granted by the materialman. However, in all cases, the tax must be remitted within one year of the date of sale. For 
more information, including special record keeping requirements, see TSB‑M‑99(2)S, Materialmen ‑ Pay When Paid.
For you to take advantage of this option, the Tax Department must receive this application by June 1 of each year.

                                                         Eligibility requirements
In any two quarterly sales tax periods within the most recent four consecutive quarterly sales tax periods, were you:

1. A materialman within the meaning of section two of the Lien Law? (In general, the Lien Law
   defines a materialman as any person who furnishes material or the use of machinery, tools, or
   equipment, or compressed gases for welding or cutting, or fuel or lubricants for the operation of
   machinery or motor vehicles, to an owner, contractor, or subcontractor, for the improvement
   of real property.) ..............................................................................................................................   Yes   No

2. Primarily engaged (more than 50% of sales) in selling building materials to contractors,
  subcontractors, or repairmen, for the improvement of real property? ............................................   Yes                                     No

3. Authorized by the Lien Law to file a mechanic’s lien upon such real property and
  improvement to real property? ........................................................................................................   Yes               No
If you answered Yes to all three questions, you are a qualified materialman and eligible to remit sales tax under the 
pay‑when‑paid option.

Certification: I certify that the above statements are true, complete, and correct, and that no material information has been omitted. I make these 
statements with the knowledge that willfully issuing a false or fraudulent statement in this document with the intent to evade any such tax may 
constitute a felony or other crime under New York State Law, punishable by a substantial fine and a possible jail sentence. I also understand that 
the Tax Department is authorized to investigate the validity and the accuracy of any information entered on this document.
 Signature of vendor                                                                                                       Date
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  Need help?
                                                                                    Telephone assistance
               Internet access: www.tax.ny.gov                                      Sales Tax Information Center:                                          (518) 485-2889
                (for information, forms, and publications)                          To order forms and publications:                                       (518) 457-5431

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                                                        Mail to:  NYS TAX DEPARTMENT
                                                                SALES TAX REGISTRATION UNIT
                                                                W A HARRIMAN CAMPUS
                                                                ALBANY NY 12227