New York State Department of Taxation and Finance
ST-119.5
Exemption Certificate for Hotel or Motel (12/10)
Occupancy by Veterans Organizations
New York State and Local Sales and Use Tax
Type or print all entries and attach a photocopy of Form ST-119, Exempt Organization Certificate.
Name of veterans organization Telephone number
( )
Name of representative renting room Date(s) of occupancy
Purpose of travel
Representative’s signature (other than officer below) EX number from Form ST-119 copy attached
Name of hotel or motel
Street address City State ZIP code
Certification
I certify that the representative named above is acting on behalf of our veterans organization, and will be reimbursed by us for the rental of a hotel or
motel room on the above date(s) of occupancy. I certify that the above statements are true, complete, and correct, and that no material information has
been omitted. I make these statements and issue this exemption certificate with the knowledge that this document provides evidence that state and
local sales or use taxes do not apply to a transaction or transactions for which I tendered this document and that willfully issuing 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 understand that this document is required to be filed with, and delivered to the vendor as agent for the Tax Department for the purposes
of section 1838 of the Tax Law and is deemed a document required to be filed with the Tax Department for the purpose of prosecution of offenses.
I also understand that the Tax Department is authorized to investigate the validity of tax exclusions or exemptions claimed and the accuracy of any
information entered on this document.
Name and title of officer of veterans organization Officer’s signature Date prepared
Instructions
Who may use this certificate • a photocopy of the organization’s Form ST-119 is attached;
Representatives of a veterans organization traveling on the and
organization’s behalf may use this form together with Form ST-119 • the representative shows you photo identification or a current
to certify their exemption from paying state-administered credit card with signature. If there is no photo identification,
New York State and local sales taxes (but not from or the bill is paid in cash, the bill must be signed in your
locally-administered hotel taxes). presence and you must compare the signature to the
signature on this form.
To the representative renting the room:
You may accept cash, or the representative’s personal check
When you have completed Form ST-119.5, attach a copy of the or credit card, but your bill must list the representative and the
Form ST-119 that the Tax Department issued to your veterans veterans organization as purchasers of the hotel occupancy.
organization, and give both forms to the hotel or motel operator.
Show the operator your photo identification, or a current credit The representative must present this form before checkout.
card with your signature. If you have neither, or you pay the bill A separate certification is required for each occasion that the
in cash, sign the bill in the presence of the operator so your representative rents a room, as well as for each representative
signature can be compared with the signature on this form. of the veterans post or organization.
You may not reproduce this form with signatures. This form See N-93-28, Hotel and Motel Sales Tax Exemptions for
is invalid if it includes photocopies of signatures of officers Authorized Representatives of Veterans’ Organizations, for more
or representatives. Misuse of this certificate will result in information.
substantial civil or criminal penalties, or both.
As a New York State registered vendor, you may accept
To the hotel or motel operator: Form ST-119.5 in lieu of collecting tax. You will be protected
from liability if:
You may exempt the above-named veterans organization’s
representative from paying state-administered New York State • you have no knowledge that the form is false or fraudulently
and local sales and use taxes (but not from locally-administered given, and you exercise reasonable care;
hotel taxes) when renting a room from your establishment if: • the form is in your possession within 90 days of the
• all entries on this form are complete; transaction; and
• it is signed by both the representative and an officer of the • all required entries on the form are completed.
veterans organization (who must not be the same person);
Substantial penalties will result from misuse of this certificate.