Text extracted via OCR from the original document. May contain errors from the scanning process.
T.V.A. N° d'identification
FR : 03 402 315 063
FBO/ Benjamin
/// 3492
FBO/Joshua
FBO/Alexander
FBO/Victoria
John Hannan, Trustee
c/o Apollo Management
Two Manhattanville Road
PURCHASE, NY 10577
Paris, le 7 mars 2001
FACTURE N° 200103273
ALEXANDER CALDER (1898-1976)
alPertreat de Tanana Liget
Sculpture en fil de Ter / Iron wire sculpture.
1930.
H: 40 cm / H: 16 in.
PRDC : 925 000,00 USD
NY USE
FAX 418 / 1y0,9fici
GALERIE CAZEAU •BERAUDIERE
16, avenue Matignon 75008 Paris France -
:33 I 45 63 09 00 • Fax : 33 1 45 63 09 90
RC S B Paris 402 335 063 Sieve 403 113 063 00014 APE 523 Z
EFTA_R1_01947138
EFTA02672888
PH
I
L
I PPE
CAZEAU
JACQUES
DE
LA BÉRAUDIÈRE
PROVENANCE:
Fernand Léger / Nadia Léger.
Georges Bauquier.
En prêt au Musée Fernand Léger, jusqu'a la mort de Georges Bauquier.
Madame Georges Bauquier.
Collection particulière, Monaco / Private collection, Monaco.
BIBLIOGRAPHIE:
Alexander Calder,(magazine) Udgivet of Louisiana-Humblebaek. June 1969. Illustrated
page 9.
Calder's Universe, Jean Lipman, Viking Press & The Whitney Museum of American
Art.(1976-1977). Reproduced page 243.
Calder Intimate,by Daniel Marchesseau. Solange Thierry Éditeur, La Bibliothèque des
Arts, Paris. Reproduced in pages 138 & 139.
Alexander Calder (mobiles) & Fernand Léger (peintures), Louis Carré & Cie. 1988. 13
octobre-26 novembre 1988. Reproduit page 24.
Alexander Calder, Musée d'Art Moderne de la Ville de Paris, 10 juillet - 6 octobre 1996.
Illustré page 171.
Fernand Léger, Peindre la Vie Moderne. Par Arnauld Pierre,
Gallimard/CentreGeorges-Pompidou, 1997. Reproduit page 103.
Banque de l'Union Maritime et Financière
56, rue de Provence 75009 Paris, France
N° de compte : 22 11 00 17 913 0
Clé RIB : 78
Code guichet : 0001
Code Banque : 43 989
Code Swift : UMARFRPP
Correspondants à NEW YORK: Chase Manhattan Bank. Account N b: 544 715 995
4 New York Plaza, Floor 15th, New York, NY 10004. Tél : 212 - 270 6000
GALERIE CAZEAU -BÉRAUD1ÈRE
16, avenue Matignon 75008 Paris France - Tél. : 33 I 45 63 09 00 - Fax : 33 I 45 63 09 90
RC S B Paris 401 31$ 063 Sint 402 315 063 00014 APE 515 2
EFTA_R1_01947139
EFTA02672889
Via Fax
To:
From:
Barry Cohen
Bear Stearns
John J..Hannan
Apollo Management
Re:
Wire Transfer
Date:
March 27, 2001
Would you please wire transfer $685,000.00 ($171,250 for
each of the Black children) as shown below. This amount
represents the purchase of a Calder painting and a
Giacometti Table. The cash should be available from the
sale of Cendant stock last week.
The Chase Manhattan Bank, N.A.
ABA# 021 000 021
4 New York Plaza, 15th £1.
Account #: 544 715 995
ABA #: 021-000-021
A/C Title: Banque de l'intion Maritime at Financiere
For further credit tot Galerie Cazeau-Beraudiere
A/C #2 22 11 00 17 913 0
If you need any further information, please let me know.
..-2
f. -;1-1S
EFTA_R1_01947140
EFTA02672890
Jacques de la Beraudiere
Calder
925,000
Giacometti Table
240.000
1,165,000
Credit for Derain
-480.Q00
Total
685,000
Chase Manhattan Bank
4 New York Plaza, 15th Floor
New York, NY 10004
ABA #: 021-000-021
A/C Title: Banque de 1'Union Maritime et Finanriere
A/C #: 544 715 995
For Further Credit to: Galerie Cazeau-Beraudiere
A/C #: 22 11 00 17 913 0
EFTA_R1_01947141
EFTA02672891
III BROADWAY
NEW YORK, N.Y. 10006
Tel. (212) 240-0440
Fax (212) 964-9620
NAME OF CLIENT:
FORM TITLE:
DUE DATE:
PAYMENT DUE:
Grantor UAD 1992 Trust
NY State Dept. of Taxation and Finance
Purchaser's Report of Sales and Use Tax
Form ST-130
•
00d
4/2 5/C ;2-
AS SO.O_N AS POSSIBLE
S 22,185.12
171
g8, 7 SO
t-k-)
MAKE CHECK PAYABLE TO: New York State Sales Tax
MAIL TO:
NYS Tax Department
Sales Tax Desk Audit
Casual Sales Unit
Building 9, 3rd Flr.
W A Harriman Campus
Albany, NY 12227-0125
lizt.w
(1) Please sign where indicated. V0P4--v
4,t
)
(2) Mail with the attached envelope
(3) Indicate Alexander Calder: "Portrait de Fernand Leger" Our PA44 owt—c 0
P-ect-rd
/9 7 f
/g7-2.
/44 7.3
/v7v
EFTA_R1_01947142
EFTA02672892
T.V.A. N° d'identification
FR : 03 402 315 063
FBO /Benjamin
FBO/Joshua
FBO/Alexander
FBO/Victoria
John Hannan, Trustee
c/o Apollo Management
Two Manhattanville Road
PURCHASE, NY 10577
Paris, le 7 mars 2001
FACTURE N° 200103273
ALEXANDER CALDER (1898-1976)
gilFortniti t
Ferns:and User
Sculpture en fil de fer / Iron wire sculpture.
1930.
H: 40 cm / H: 16 in.
PRIX : 925 000,00 USD
16, avenue Matignon 75008 Paris France - TEL:33 I 45 63 09 00 Fax
33 I 45 63 09 90
RCS], Paris 402 315 063 Slru 1'01 31S 063 00014 APE 525 Z
EFTA_R1_01947143
EFTA02672893
New York State Department of Truation and Finance
Purchaser's Report of Sales and Use Tax
ST-130
(MO)
Do not use this form if you are required to register as a vendor with the New York State Tax Department or are reporting the purchase of a
motor vehicle, snowmobile, vessel, or all-terrain vehicle that must be registered or titled by the Department of Motor Vehicles.
A a print clearly
For office use only
rub name oast and first/
Social security number
D. BLACK. B. COHEN & J. HANNAN TRUSTEES FB0 JOSHUA BLACK(11/30/92)
Home address (number end street or rural route)
C/o J. HANNAN, TTEE, 1301 AVE., OF THE AMERICAS
City, village, or post office
State
NEW YORK NY 10019
Business name and address, if different from above
Federal identification number (deny)
13/002819
ZIP code
Location code
Tax jurisdiction code
Taxable sales
Sales and use tax
Part I — Summary of purchases — If you are reporting the purchase of more than one item or service, attach a list showing
the information requested on lines 1 through 12 for each item or service.
1 Item purchased or service rendered Ofurniture 0
furs 0
jewelry El utility gas 0
other
and electricity pdenlaW1/4 interest art work
2 Date brought into New York State Mar. 7. 2001
(see instructions) Alexander Calder: "Portrait de F.Leger"
3
Method of delivery D purchaser pick up K US Postal Service 0
UPS 0
seller's vehicle 0
other
(dently)Private carrier
4 Location where item was delivered . . City New York
County New York
State NY
5 Location where item is used
City New York
County New York
State NY
6
Seller's name and address Philippe Cazeau, Paris, France
City
State
Part II — Summary of taxes due
7 Amount subject to sales or compensating use tax (see instructions)
7
231,250
8
Tax rate applicable where item was delivered
8
8.25
9
Tax rate applicable where item is used
9
oA
10
Tax due (multiPly fine 7 by The 8 or 9; see instructions)
10
19.078. 13
11
Amount of sales tax paid (if any) to:
City
County
State
11
12
Total New York State sales or use taxes due (subtract ine 11 from fine 10)
12
19,078. 13
13
Penalty and interest — if you are filing late, see instructions
13
3,106. 39
14
Total amount due (add/lies 12 and 13)
Attach check or money order payable to: New York State Sales Tax
14
22,185. 12
I hereby certify that to the best of my knowledge and belief, this is a true, correct, and complete return.
Willfully filing a false return is a crime under the Tax Law.
Purchaser's signature
Date
Prepares signature (if other than purchaser)
Prepares social security number
153.38.2770
Date
Preparers address 111 Broadway, 8th Fl r.
New York, NY 10006
Employer Identification number
13.3959372
For office use only
Mail this return and payment to:
1ASUAL SALES UNIT
JUILDING 9 3RD FLOOR
ALBANY NY 12227-0125
S11 NY40568F
EFTA_R1_01947144
EFTA02672894
New York State Department of Taxation and Finance
Purchaser's Report of Sales and Use Tax
ST-130
(7)00)
Do not use this form if you are required to register as a vendor with the New York State Tax Department or are reporting the purchase of a
motor vehicle, snowmobile, vessel, or all-terrain vehicle that must be registered or titled by the Department of Motor Vehicles.
or print cleats
Full name past and first)
D. BLACK. B. COHEN & J HANNAN TRUSTEES FBO ALEXANDER BLACK1111304
Home address (number and street or rural route)
do J. HANNAN, TTEE, 1301 AVE OF THE AMERICAS
City, village. or post office
State
NEW YORK NY 10019
Business name and address, if different from above
Social security number
21
Federal identification number (if any)
13.7002820
ZIP code
For office use only
Location code
Tax Jurisdiction code
Taxable sales
Sales and use tax
Part I — Summary of purchases — If you are reporting the purchase of more than one item or service, attach a list showing
the information requested on lines 1 through 12 for each item or service.
1 Item purchased or service rendered n furniture 0
furs Ojewelry Outility gas pother
and electricity (identify) 1/4 interest art work
2
Date brought into New York State Mar. 7. 2001
(see insfructions) Alexander Calder: Portrait de F.Leger"
3
Method of delivery Ei purchaser pick up El US Postal Service El UPS K
seller's vehicle E other
(dente?) Private carver
4 Location where item was delivered . . City New York
County New York
State NY
5
Location where item is used
City New York
County New York
State NY
6
Seller's name and address Philippe Cazeau, Paris, France
City
State
Part II — Summary of taxes due
7
Amount subject to sales or compensating use tax (see instructions)
8
Tax rate applicable where item was delivered
9
Tax rate applicable where item is used
10
Tax due (multiply line 7 by Ire 8 or 9: see ins(ructions)
11 Amount of sales tax paid (if any) to:
City
County
State
12
Total New York State sales or use taxes due (subtract Me 11 from km 10)
13
Penalty and interest — if you are filing late, see instructions
14
Total amount due (add aws 12 and 13)
Attach check or money order payable to: New York State Sales Tax
I hereby certify that to the best of my knowledge and belief, this is a true, correct, and complete return.
Willfully filing a false return is a crime under the Tax Law.
Purchaser's signature
7
8
9
231,250
8.25
10
11
19.078. 3
12
13
14
19,078.
3,106.
22,185.
13
99
12
Date
Preparer's signature (if other than purchaser)
Preparers address 111 Broadway, 8th Fl r.
New York, NY 10006
For office use only
Mail this return and payment to:
dUILDING 9 3RD FLOOR
ALBANY NY 12227-0125
Preparer's social security number
[SSN REDACTED]
Date
Employer identification number
13-3959372
STF NY40568F
EFTA_R1_01947145
EFTA02672895
III BROADWAY
NEW YORK, N.Y. 10006
Tel. (212) 240-0440
Fax (212) 964-9620
NAME OF CLIENT:
Grantor UAD 1992 Trust
FORM TITLE:
NY State Dept. of Taxation and Finance
Purchaser's Report of Sales and Use Tax
Form ST-130
DUE DATE:
PAYMENT DUE:
22,185.12
MAKE CHECK PAYABLE TO: New York State Sales Tax
MAIL TO:
NYS Tax Department
Sales Tax Desk Audit
Casual Sales Unit
Building 9, 3'd Fir.
W A Harriman Campus
Albany, NY 12227-0125
(1) Please sign where indicated.
(2) Mail with the attached envelope
(3) Indicate Alexander Calder: "Portrait de Fernand Leger"
EFTA_R 1_01947146
EFTA02672896
New York State Departrnem of Taxation and Finance
Purchaser's Report of Sales and Use Tax
ST-130
(7100)
Do not use this form if you are required to register as a vendor with the New York State Tax Department or are reporting the purchase of a
motor vehicle, snowmobile, vessel, or all-terrain vehicle that must be registered or titled by the Department of Motor Vehicles.
* or print clearly
For office use only
Full name (last and first)
Social security number
Location code
D. BLACK. B. COHEN & J. HANNAN TRUSTEES FBO BENJAMIN BLACK(11/30,32,
Home address (number and street or rural route)
do J. HANNAN, TTEE. 1301 AVE., OF THE AMERICAS
City, village. a post office
NEW YORK NY 10019
Business name and address, if different from above
Federal identification number Of any)
13.7002818
State
ZIP code
Taxjurisdiction code
Taxable sales
Sales and use tax
Part 1 — Summary
the
1
2
of purchases — If you are reporting the purchase of more than
information requested on lines 1 through 12 for each item or service.
one item or service, attach
❑utility gas El other
and electna•ty
(identify)
insaucuons) Alexander Calder:
a list showing
1/4interest art work
Item purchased or service rendered Ei furniture 0
furs Ojewelry
Date brought into New York State Mar. 7, 2001
(see
'Portrait de F.Leger"
3
0
UPS ci seller's vehicle 0
other
Method of delivery K purchaser pick up K US Postal Service
(dente) private cagier
4 Location where item was delivered
City New York
County New York
State NY
5
Location where item is used
City New York
County New York
State NY
6
Seller's name and address Phi I ince Cazeau, Paris, France
City
State
Part
— Summary of taxes due
7
Amount subject to sales or compensating use tax (see instructions)
7
231,250
8
Tax rate applicable where item was delivered
8
8.25
cYo
9
Tax rate applicable where item is used
9
10
Tax due (mutply fine 7 by fine 8 or 9; see instructions)
10
19,078. 3
11 Amount of sales tax paid (if any) to:
City
County
State
11
12
Total New York State sales or use taxes due (subtract km 11 from km 10)
12
19,078. 13
13
Penalty and interest — if you are filing late, see instructions
13
3,106. 9
14
Total amount due (add hies 12 and 13)
Attach check or money order payable to: New York State Sales Tax
14
22,185. 12
I hereby certify that to the best of my knowledge and belief, this is a true, correct, and complete return.
Willfully filing a false return is-a•crime under: theTax Law.
Purchaser's signature
Date
Preparer's signature (ilothey than purchaser)
Preparer's social security number
153-38.2770
Date
FreParer's address 111 Broadway, 8th Fl r.
New York, NY 10006
For office use only
Mail this return and payment to:
:ASUAL SALES UNIT
BUILDING 9 3RD FLOOR
ALBANY NY 12227-0125
Employer identification number
13.3959372
SW NY40568F
EFTA_R1_01947147
EFTA02672897
New York State Department of Taxation and Finance
Purchaser's Report of Sales and Use Tax
ST-130
(7)00)
Do not use this form if you are required to register as a vendor with the New York State Tax Department or are reporting the purchase of a
motor vehicle, snowmobile, vessel, or all-terrain vehicle that must be registered or titled by the Department of Motor Vehicles.
e or print Beady
rift name (lest and first)
p. BLACK. B. COHEN & J. HANNAN TRUSTEES FI30 VICTORIA BLACKel 1 /3D/921
Home address (number and sheet or rural route)
c/o J. HANNAN, TTEE, 1301 AVE., OF THE AMERICAS
City, village, or post office
State
NEW YORK NY 10019
Business name and address, if different from above
Social security number
Federal identification number Of any)
13.7002821
ZIP code
For office use only
Location code
Tax jurisdiction code
Taxable sales
Sales and use tax
Part I — Summary of purchases — If you are reporting the purchase of more than one item or service, attach a list showing
the information requested on lines 1 through 12 for each item or service.
1 Item purchased or service rendered O furniture Ci furs
jewelry O utility gas El other
and electricity
• •
Oen*/ 1/4 interest art work
2 Date brought into New York State Mar. 7. 2001
(see enstructions) Alexander Calder: 'Portrait de F.Lege(
3 Method of delivery O purchaser pick up O US Postal Service DI UPS ID seller's vehicle 0 other
(identify) private carrier
4 Location where item was delivered . . City New York
County New York
State NY
5 Location where item is used
City New York
County New York
State NY
6
Seller's name and address Philippe Cazeau, Paris, France
City
State
Part II — Summary of taxes due
7
Amount subject to sales or compensating use tax (see instructions)
7
231,250
8
Tax rate applicable where item was delivered
8
8.25
'Ye
9
Tax rate applicable where item is used
9
04
10
Tax due (multiply tine 7 by Me 8 or 9; see instructions)
10
19,078. 13
11 Amount of sales tax paid (if any) to:
City
County
State
11
12
Total New York State sales or use taxes due (subtract Me 11 from Me 10)
12
19.078. 13
13
Penalty and interest — if you are filing late, see instructions
13
3,106. 39
14
Total amount due (add lines 12 and 13)
Attach check or money order payable to: New York State Sales Tax
14
22,185. 12
I hereby certify that to the best of my knowledge and belief, this is a true, correct, and complete return.
Willfully filing a false return is a crime ender the Tax Law.
Purchaser's signature
Date
Preparer's signature (if other teen purchaser)
Preparer's social security number
153.38.2770
Date
Preparers address 111 Broadway, 8th FIr.
New York, NY 10006
For office use only
Mail this return and payment to:
;ASUAL SALES UNIT
BUILDING 9 3RD FLOOR
ALBANY NY 122274125
Employer identification number
13-3959372
STF NY405e8F
EFTA_R1_01947148
EFTA02672898
(Domestic Mail Only; No Insurake Cov&ago Provided)
3984 0758
O
7000 1670
PO
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07/01/02
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1~L BYINY. NY 12227
• Complete items 1. 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
• Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece
or on the front if space permits.
1. Article Addressed to:
N t 5
7AX DEPT
SALES. Tro"DESK• AUDIT
CASUAL 54Les UNtr-
BLI)Cr q,
3RD FL
HAuffnAiv CAmPo,5
ALBANY, NY /2227
B. Date of Deliver
C. Signature
X
D. Is doWery atfidnasscfiffenint from ilem 1?
ncyp, enIer deeney address below:
NeDglin;1‘, 5
a,*
O Agent
▪ Address°
O Yes
O No
3. Service Type
Xeartified Mai
O Express Mail
O Registered
.E(Raturn Receipt tom Merchandis
O Insured Mai
O C.O.D.
4. Restricted Delivery? Wes Fes)
O Yes
2. Article Number (Copy from service label) 7<-60
/t70
boa; 3 415'1 0757
PS Form 3811, July 1999
Domestic Return Receipt
102595-004A-0952
EFTA_R1_01947149
EFTA02672899
III BROADWAY
NEW YORK, N.Y. 10006
Po-i,c‘we
Tel. (212) 240-0440
Fax (212) 964-9620
NAME OF CLIENT:
Grantor UAD 1992 Trust
FORM TITLE:
DUE DATE:
PAYMENT DUE:
MAKE CHECK PAYABLE TO: New York State Sales Tax
MAIL TO:
NYS Tax Department
Sales Tax Desk Audit
Casual Sales Unit
Building 9, 3n0 Flr.
W A Harriman Campus
Albany, NY 12227-0125
NY State Dept. of Taxation and Finance
Purchaser's Report of Sales and Use Tax
Form ST-130
pi
47,25/0 a.
X
4/
- -, IS')
e}.4
/v7.2.
74c73
/417y
Voi
tA)
(1) Please sign where indicated.
(2) Mail with the attached envelope
(3) Indicate Alexander Calder: "Portrait de Fernand Leger" Our /°44.4 crot..4
paw" @Lit)
EFTA_R1_01947150
EFTA02672900
New York Slate Department of Taxation and Finance
Purchaser's Report of Sales and Use Tax
ST-130
(7)00)
Do not use this form if you are required to register as a vendor with the New York State Tax Department or are reporting the purchase of a
motor vehicle, snowmobile, vessel, or all-terrain vehicle that must be registered or titled by the Department of Motor Vehicles.
or print deafly
si name (last and first)
Social security number
D. BLACK. B. COHEN 8 J. HANNAN TRUSTEES FBO ALEXANDER BlACK(11/30/421
Hanle address (number and street or rural route)
do J. HANNAN, TTEE. 1301 AVE. OF THE AMERICAS
City, village, or post office
State
NEW YORK NY 10019
Business name and address, if different from above
Federal identtheahon number (if any)
13-7002820
ZIP code
For office use only
location cede
Taxjurisdiction code
Taxable sales
Sales and use lax
Part 1— Summary
the
1
2
of purchases — If you are reporting the purchase of more than one item or service, attach a list showing
information requested on lines 1 through 12 for each item or service.
Item purchased or service rendered El furniture 0
furs 0
jewelry 0
utility gas 0
other
and electricity
Ode n WY) 1/4 interest art work
Date brought into New York State Mar. 7, 2001
(see instnactions) Alexander Calder: "Portrait de F.Leger"
3 Method of delivery El purchaser pick up El US Postal Service El UPS 0
seller's vehicle
other
0denbry)Plivate carrier
4 Location where item was delivered
City New York
County New York
State NY
5
Location where item is used
City New York
County New York
State NY
6
Seller's name and address Philippe Cazeau, Paris, France
City
State
Part 11 — Summary of taxes due
7 Amount subject to sales or compensating use tax (see instructions)
7
231,250
8
Tax rate applicable where item was delivered
8
8.25
9
Tax rate applicable where item is used
9
10
Tax due (multiply fine 7 by the 8 of 9: see instructions)
10
19.078. 3
11 Amount of sales tax paid (if any) to:
City
County
State
11
12
Total New York State sales or use taxes due (subtract tine 11 from tine 10)
12
19,078. 3
13 Penalty and interest — if you are filing late, see instructions
13
3106. 9
14
Total amount due (add ;nes 12 and 13)
Attach check or money order payable to: New York State Sales Tax
14
22,185. 2
I hereby certify that to the best of my knowledge and belief, this is a true, correct, and complete return.
Willfully filing a false return is a crime under the Tax Law.
ialiENT
r
COPY
Purchaser's signature
Date
Prepares signature Mother than purchaser)
Peepers's address 111 Broadway, 8th Fl r.
New York, NY 10006
Mail this return and payment to:
SUAL SALES UNIT
JILDING 9 3RD FLOOR
ALBANY NY 12227-0125
Peepers's social security number
153.38.2770
For of Ice use only
Date
Employer Identification number
13-3959372
SW N3/4105G8F
EFTA_R1_01947151
EFTA02672901
4
New York State Depanmenl or Taxation and Finance
Purchaser's Report of Sales and Use Tax
ST-130
(7100)
Do not use this form if you are required to register as a vendor with the New York State Tax Department or are reporting the purchase of a
motor vehicle, snowmobile, vessel, or all-terrain vehicle that must be registered or titled by the Department of Motor Vehicles.
tt or print clearly
name pest and &SO
D. BLACK. B. COHEN & J. HANNAN TRUSTEES FB0 VICTORIA BLACK(11130192)
Home address (number and street or rural route)
Go J. HANNAN, TTEE, 1301 AVE.. OF THE AMERICAS
City, village• or post office
State
ZIP code
NEW YORK NY 10019
Business name and address, if different from above
Social security number
Federal Identification number (dony)
13.7002821
For office use only
Location code
Tax jurisdiction code
Taxable sales
Sales and use tax
Part I — Summary of purchases — If you are reporting the purchase of more than one item or service, attach a list showing
the information requested on lines 1 through 12 for each item or service.
1 Item purchased or service rendered 0
furniture 0
furs
jewelry K utility gas 0
other
Ode/it/Al/4 interest art work
and electricity
2
Date brought into New York State Mar. 7, 2001
(see instructions) Alexander Calder: 'Portrait de F.Leger"
3
Method of delivery 0
purchaser pick up 0
US Postal Service 0
UPS 0
seller's vehicle E other
(idenely)Private carrier
4
Location where item was delivered . . City New York
County New York
State NY
5
Location where item is used
City New York
County New York
State NY
6
Seller's name and address Philippe Cazeau, Paris, France
City
State
Part II - Summary of taxes due
7 Amount subject to sales or compensating use tax (see Instructions)
8
Tax rate applicable where item was delivered
9
Tax rate applicable where item is used
10
Tax due (multiply Ana 7 by he 8 or 9; see ihstructkos)
11 Amount of sales tax paid (if any) to:
City
County
State
12
Total New York State sales or use taxes due (subtract hie 11 from One 10)
13
Penalty and interest — if you are filing late, see instructions
14
Total amount due (add Ines 12 and 13)
Attach check or money order payable to: New York State Sales Tax
7
8
9
231,250
8.25
10
11
19,078.13
12
13
19,078.
3,106.
13
)9
14
22,185. 12
I hereby certify that to the
Willfully filing a false return s a cri*,*giherr
Purchaser's signature
Awl
t of inyamowledge and belief, this is a true, correct, and complete return.
t•
Date
Pmparer's signature Of other than Purchase°
Preparers address 111 Broadway, 8th Fir.
New York, NY 10006
Mail this return and payment to:
- ASUAL SALES UNIT
.UILDING 9 3RD FLOOR
ALBANY NY 12227-0125
Preparers social security number
153.38.2770
For office use only
Date
Employer identification number
13.3959372
STF NY40568F
EFTA_R1_01947152
EFTA02672902