NY ST-124


After this certificate is completed and signed by both the customer and the contractor performing the capital improvement, it must be kept by the contractor. Copies of this certificate must be furnished to all subcontractors on the job and retained as part of their records.

Read this form completely before making any entries.

This certificate may not be used to purchase building materials exempt from tax.

Name of contractor (print or type)

Name of customer (print or type)

Address (number and street)

Address (number and street)

City

State

ZIP code

City

State

ZIP code

 

 

Sales tax Certificate of Authority number (if any)

To be completed by the customer
Describe capital improvement to be performed:

 

 

Project name

Street address (where the work is to be performed)

City

State

ZIP code

I certify that:

  • I am the (mark an X in one)      owner        tenant of the real property identified on this form; and
  • the work described above will result in a capital improvement to the real property as outlined in the instructions of this form; and
  • this contract (mark an X in one)      includes        does not include the sale of any items that will not become a permanent part of the real property (for example, a free-standing microwave or washing machine).

I understand that:

  • I will be responsible for any sales tax, interest, and penalty due on the contractor’s total charge for tangible personal property and for labor if it is determined that this work does not qualify as a capital improvement; and
  • I will be required to pay the contractor the appropriate sales tax on tangible personal property (and any associated services) when the property installed by the contractor does not become a permanent part of the real property; and
  • I will be subject to civil or criminal penalties (or both) under the Tax Law if I issue a false or fraudulent certificate.

Signature of customer

Title

Date

November 29, 2021

 

To be completed by the contractor

I, the contractor, certify that I have entered into a contract to perform the work described by the customer named above, and that I accept this form in good faith. (A copy of the written contract, if any, is attached.) I understand that my failure to collect tax as a result of accepting an improperly completed certificate will make me personally liable for the tax otherwise due, plus penalties and interest.

Signature of contractor or officer

Michael Wheeler

Title

Owner

Date

November 29, 2021

This certificate is not valid unless all entries are completed.

 

Leave this empty:

Signature arrow sign here

Signed by Michael Wheeler
Signed On: March 31, 2021


Signature Certificate
Document name: NY ST-124
lock iconUnique Document ID: 36a6260dd4172dc827b0bbeba46c74452341f27f
Timestamp Audit
March 31, 2021 12:17 pm EST NY ST-124 Uploaded by Michael Wheeler - alexp@prospectgenius.com IP 104.228.22.28