Department of Taxation and Finance Statement of Transaction ­ Claim for Credit of Sales Tax Paid to Another State For Motor Vehicle, Trailer, AllTerrain Vehicle (ATV), Vessel (Boat), or Snowmobile DTF804 (5/15) UseofthisformisrestrictedtotransactionsprocessedbycountyclerkofficesortheDepartmentofMotorVehiclesanditsagents. Note: Misuse of this form may subject you to serious civil and criminal sanctions in addition to the payment of any tax and interest due. Type or print. Read instructions on page 2 before completing this form. Owner SSNorEIN Lastname,firstname,middleinitial(orbusinessname) Numberandstreetaddress City County State Lastname,firstname,middleinitial(ordealershipname) Numberandstreetaddress City Purchased from ZIPcode County State ZIPcode Vehicletype: Motorvehicle(includestrailers) Boat/Trailer combination All-terrainvehicle Snowmobile ft. Boat (length in feet): Vehicleorhullidentificationnumber Year Make Model Boatsandboat/trailercombinationsonly­entertrailerinformationbelow Year Make Model Vehicleidentificationnumber Date of purchase: mm / dd / yyyy Purchaseprice:$ DatevehicleenteredNewYorkState: mm / dd / yyyy Enternameoftheotherstatewheresalestaxwaspaid Refertothechartonbacktodetermineifyouareeligibletoclaimacreditfromthestatetowhichyoupaidtax. 1 2 3 4 5 6 7 AmountsubjecttoNewYorkStatetax(for boats and boat/trailer combinations purchased or used on or after June 1, 2015, do not enter more than $230,000; see instructions) ........................................................................... 1 2 3 % CombinedNewYorkStateandlocaltaxrate(enter the tax rate imposed within your jurisdiction of residence) ......... NewYorkStateusetaxdue(multiply line 1 by line 2) .......................................................................................... Enterthetaxratepaidtootherstate...................................................................... 4 % Tax rate eligible for reciprocal credit (see instructions) ......................................................................................... Reciprocal credit (multiply line 1 by line 5) ............................................................................................................ NetNewYorkStateusetaxdue(subtract line 6 from line 3; this amount cannot be less than zero) ........................... 5 6 7 % Certification: Icertifythattheabovestatementsaretrue,complete,andcorrect,andthatnomaterialinformationhasbeenomitted.Imakethese statementsandissuethisexemptioncertificatewiththeknowledgethatthisdocumentprovidesevidencethatstateandlocalsalesorusetaxesdo notapplytoatransactionortransactionsforwhichItenderedthisdocumentandthatwillfullyissuingthisdocumentwiththeintenttoevadeanysuch taxmayconstituteafelonyorothercrimeunderNewYorkStatelaw,punishablebyasubstantialfineandpossiblejailsentence.Iunderstandthat thisdocumentisrequiredtobefiledwith,anddeliveredtotherecipientasagentfortheTaxDepartmentforthepurposesofTaxLawsection1838, andisdeemedadocumentrequiredtobefiledwiththeTaxDepartmentforthepurposeofprosecutionofoffenses.IalsounderstandthattheTax Department is authorized to investigate the validity of tax exclusions or exemptions claimed and the accuracy of any information entered on this document. Signatureofowner(sign in full) Printednameofowner Date / / Privacy notification ­ SeeourWebsiteatwww.tax.ny.govorPublication54,Privacy Notification. Taxablevaluation Taxrate Taxdue Initials For office use only Office Date / / Affidavitsubmitted Proofofpaymentsubmitted Possibleaudit American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2 DTF-804 (5/15) General information Instructions This form is to be used by a purchaser of a motor vehicle, all-terrain vehicle, trailer,vessel,orsnowmobile(qualifying vehicle or vessel) to report the salesandusetaxdueonapurchaseforwhichthepurchaserwantstoclaim a credit for sales tax paid to another state. ANewYorkStateresidentwhopurchasesaqualifyingvehicleorvessel outsidethestatebecomesliableforNewYorkStateandlocalsalesanduse taxifthequalifyingvehicleorvesselisbroughtintothestate.However,a creditagainsttheNewYorktaxduemaybeavailableifallofthefollowing apply: · Thebuyerwasrequiredtopaytaxtoanotherstateonthepurchase; · thatstateprovidesareciprocaltaxcreditthatissimilartothetaxcreditfor NewYorkState;and · thebuyerisnotentitledtoarefundofthattaxfromtheotherstate. Ifalltheseconditionsaremet,thenthebuyermaybegrantedacredit againsttheusetaxduetoNewYorkStateforthetaxpaid(oraportionof the tax paid) to the other state. Note:Beforecompletingthisform,refertothechartsbelowtodetermineif NewYorkStateprovidesareciprocalcreditforsalestaxpaidtothestate whereyoumadeyourpurchase.For motor vehicles, New York State provides a reciprocal credit for tax paid to a very limited number of states.Ifnoreciprocalcreditisavailable,useFormDTF-802,Statement of Transaction - Sale or Gift of Motor Vehicle, Trailer, All-Terrain Vehicle (ATV), Vessel (Boat), or Snowmobile,insteadofthisform.Ifyoupaidtaxtoastate forwhichnoNewYorkStatereciprocalcreditisallowedyoushouldapply tothatstateforarefund.Ifthestatedeniestherefundyoumaybeeligible foracreditforsomeoralloftheNewYorktaxyoumustpaynow.Toapply, fileFormAU-11,Application for Credit or Refund of Sales or Use Tax, and attach proof of tax payment to and proof of the refund denial by the other state. · Enterthedateofpurchaseandthepurchaseprice.Purchase price includes any monetary consideration, the value of any property exchangedortraded(otherthanatrade-inallowancegrantedbya dealer), and any assumption of a debt or liability of the seller. Also enter thedatethevehicleenteredNewYorkState. · Enterthenameofthestatetowhichthesalestaxwaspaid. Line 1 ­EntertheamountsubjecttoNewYorkStatesalestax.Thisamount iseitherthepurchasepriceenteredaboveor,ifthevehiclewasused outsideNewYorkStateformorethansixmonthsbeforeitwasbroughtinto thestate,thefairmarketvalue,whicheverislower.Fairmarketvalueis generally determined from values established by private companies. For boats and boat/trailer combinations purchased or used on or after June1,2015,theamounteligibleforcreditcannotexceed$230,000, regardlessofthepurchasepriceoftheboatortrailer.SeeTSB-M-15(2)S, Change to the Application of Sales and Use Tax on Vessels. Line 2 ­ The applicable local rate of tax on the purchase or use of a qualifyingvehicleorvesselistherateoftaxforthelocalityinwhichthe purchaserisaresident.Ifthepurchaserisaresidentofmorethanone localitywithinthestate,theapplicablelocaltaxrateistherateoftaxfor thatlocalitywh