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St 119.1 tax exempt Form: What You Should Know

I certify that the organization has a valid license to operate and has received authorization to use the form of ST-119.3, the “Exempt Organization Certificate for Motor  fuel and Diesel”. I declare under penalty of perjury that any statement in this application is a true and correct  statement to the best of my knowledge and belief. Please sign your name, date, and pay the required fee. If you are paying by check, please  put “Pay by check” in the space provided next to “Pay by Check” and enter the correct amount of the payment to the left of “Note” and hit “Submit.”  By Mail You may mail the application by U.S. Mail, postage prepaid, to the following address: Exempt Organization Certificate for Motor Fuel and Diesels Taxpayer Identification Number — TIN: 06673 State of New York 4 Empire State Plaza Albany, NY 12233 If you wish to pay by check, please write “Pay by Check” in the space provided next to “Pay by Check” and indicate your  check size in the space provided. Then, put the amount of the check payment into the space provided after the first name.  Then, use the space left on the form for your signature. If the check is paid or cleared, return the application form and all required  documents and mail completed application in the envelope to the address provided.  Do not return a completed application without having checked the box “Check and Send” above.  By Fax If you have a question about the exemption, email us at: exempt.applications tax.NY.gov Exempt Organization Exempt Purchase Certificate (Form ST-119.1) for Motor Fuel and Diesel Exercise Authority Your organization has exercised its authority to purchase fuels if it has purchased all necessary exemptions.  (The organization will not obtain an exempt-updates form unless an exemption has expired.)   Exempt Purchase Certificate, Form ST-119.1, for Motor Fuel and Diesel Date of Exemption The date of expiry of the exemption is “12/31/2026”.  The expiration date is shown in the “Exemption Expires” box on the Form ST-119.1. Form ST-119.

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