Specifications

Page 9 of 14
Page 2 of 4 ST-220-TD (6/06)
I, ____________________________ , hereby affirm, under penalty of perjury, that I am ______________________
(name) ( title)
of the above-named contractor, and that I am authorized to make this certification on behalf of such contractor.
Make only one entry in each section below.
Section 1 - Contractor registration status
The contractor has made sales delivered by any means to locations within New York State of tangible personal property or
taxable services having a cumulative value in excess of $300,000 during the four sales tax quarters which immediately
precede the sales tax quarter in which this certification is made. The contractor is registered to collect New York State and
local sales and compensating use taxes with the Commissioner of Taxation and Finance pursuant to sections 1134 and 1253
of the Tax Law, and is listed on Schedule A of this certification.
The contractor has not made sales delivered by any means to locations within New York State of tangible personal property
or taxable services having a cumulative value in excess of $300,000 during the four sales tax quarters which immediately
precede the sales tax quarter in which this certification is made.
Section 2 - Affiliate registration status
The contractor does not have any affiliates.
To the best of the contractor’s knowledge, the contractor has one or more affiliates having made sales delivered by any
means to locations within New York State of tangible personal property or taxable services having a cumulative value in
excess of $300,000 during the four sales tax quarters which immediately precede the sales tax quarter in which this
certification is made, and each affiliate exceeding the $300,000 cumulative sales threshold during such quarters is registered
to collect New York State and local sales and compensating use taxes with the Commissioner of Taxation and Finance
pursuant to sections 1134 and 1253 of the Tax Law. The contractor has listed each affiliate exceeding the $300,000
cumulative sales threshold during such quarters on Schedule A of this certification.
To the best of the contractor’s knowledge, the contractor has one or more affiliates, and each affiliate has not made sales
delivered by any means to locations within New York State of tangible personal property or taxable services having a
cumulative value in excess of $300,000 during the four sales tax quarters which immediately precede the sales tax quarter in
which this certification is made.
Section 3 - Subcontractor registration status
The contractor does not have any subcontractors.
To the best of the contractor’s knowledge, the contractor has one or more subcontractors having made sales delivered by any
means to locations within New York State of tangible personal property or taxable services having a cumulative value in
excess of $300,000 during the four sales tax quarters which immediately precede the sales tax quarter in which this
certification is made, and each subcontractor exceeding the $300,000 cumulative sales threshold during such quarters is
registered to collect New York State and local sales and compensating use taxes with the Commissioner of Taxation and
Finance pursuant to sections 1134 and 1253 of the Tax Law. The contractor has listed each subcontractor exceeding the
$300,000 cumulative sales threshold during such quarters on Schedule A of this certification.
To the best of the contractor’s knowledge, the contractor has one or more subcontractors, and each subcontractor has not
made sales delivered by any means to locations within New York State of tangible personal property or taxable services
having a cumulative value in excess of $300,000 during the four sales tax quarters which immediately precede the sales tax
quarter in which this certification is made.
Sworn to this______ day of _________, 20 ____
(sign before a notary public) (title)