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                         Department of Taxation and Finance
                                                                                                                                                                         ST-141
                         Individual Purchaser’s Periodic Report of                                                                                                                 (12/22)

                         Sales and Use Tax
You may use this form if you are an individual, estate, or trust that owes sales or use tax. Do not use this form if you are required to register for sales 
tax purposes with the New York State Tax Department or if you are reporting the purchase of a motor vehicle, trailer, all-terrain vehicle, vessel, or 
snowmobile that must be registered or titled by the New York State Department of Motor Vehicles. See Form ST-141-I, Instructions for Form ST-141.
                                                                                                                          For office use only
                                                                                                                          Tax jurisdiction code
 Purchaser’s name                                                               Social Security number
                                                                                                                          Location code
 Purchaser’s address (number and street or rural route)                         Employer identification number (if any)
                                                                                                                          Taxable sales
 City                                 County                           State     ZIP code                                 Sales and use tax

  A  Date of purchase:

  B  Description of items or services purchased:

Computation of total sales or use tax due
  1 Tax due on nonbusiness-related items or services costing less than $1,000 each excluding shipping and 
      handling (enter your tax due on all nonbusiness-related purchases where the price of each item or service was  
      under $1,000 from line 3 of Worksheet 1 on page 2)   ........................................................................................  1
  2  Supplemental tax on vapor products due on nonbusiness-related purchases costing less than $1,000  
      each excluding shipping and handling (enter your tax due on all nonbusiness-related vapor product purchases  
      where the price was under $1,000 from line 4 of Worksheet 1 on page 2)  ............................................................                              2
  3 Tax due on nonbusiness-related items or services costing $1,000 or more each (from line 1 of  
      Worksheet 2 on page 2)  .................................................................................................................................  3
  4 Tax due on business-related purchases federal schedules C and F or E (Part I )(from line 3 ofWorksheet 3
       on page 3)  .................................................................................................................................................... 4
  5  Supplemental tax on vapor products due on business-related purchases - federal schedules C and F 
       or E (Part  )I (from line 4 of Worksheet 3 on page 3).  .....................................................................................                    5
  6  Special tax on peer-to-peer car sharing due (from line 1 of Worksheet 4 on page 4)  .........................................                                      6
  7 Total sales or use tax due (add lines 1 through 6).............................................................................................  7
  8 Amount paid (enter your payment amount; this amount should match the amount due on line 7). ............................                                            8
       Attach check or money order payable in U.S. funds to New York State Sales Tax

Worksheet 1  — Exact calculation of tax due for nonbusiness-related purchases costing less than $1,000 each
Use this worksheet for nonbusiness-related purchases where each item or service costs less than $1,000, excluding shipping and handling. 
However, the shipping and handling charges must be included in column A of Part 1 and Part 2 when computing your tax due.
Part 1 – Purchases of clothing and footwear costing less than $110 per item or pair, excluding shipping and 
handling
Clothing and footwear purchases under $110 per item or pair, excluding shipping and handling, are exempt from the 4% state sales tax, the 
⅜% MCTD tax (in those localities that provide the less-than-$110 exemption), and some local taxes.
Chart 2 in the instructions lists the appropriate tax rate to enter for your locality in column B below. If your purchases qualify for both the state 
and local exemption, the rate will be 0. In this case, do not complete Part 1.
Report purchases of clothing and footwear costing $110 or more, and purchases of other taxable items or services, in Part 2 on page 2.
                 A                        B                        C                         D                                                                          E
          Purchase price or        Your sales and                 Tax            Tax paid to another                                                                    Tax due
          taxable receipts            use tax rate        (column A   ×column B) taxing jurisdiction                      (column C  -                                   column D; 
            (see instructions)        (from Chart 2;                             (see instructions)                       do not enter less than zero)
                                      see instructions)

    1    Total (add the Part 1, column E amounts; do not enter less than zero)   ......................................  1

          44100112220094
                                                                                                                                                                                   (continued)



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Page 2 of 4    ST-141 (12/22)
Part 2 – All other taxable items and services
List all other taxable items or services including clothing and footwear each costing $110 or more on which no New York State or local tax was 
collected from you at the time of purchase, or on which you owe additional local tax (see instructions). Attach additional sheets if necessary.
Note: Any unpaid sales or use tax on a motor vehicle, trailer, all-terrain vehicle, vessel, or snowmobile that must be registered or titled by the 
New York State Department of Motor Vehicles is collected at the time of registration. Therefore, do not report or pay the sales or use tax on 
these items on this form.
               A                          B                        C                          D                                                    E
      Purchase price or             Combined                     Tax                  Tax paid to another                                  Tax due
       taxable receipts        state and local rate      (column A  ×column B)        taxing jurisdiction                                  (column C  -column D;
       (see instructions)           (from Chart 1;                                    (see instructions)                                   do not enter less than zero)
                                  see instructions)

 2  Total (add the Part 2, column E amounts; do not enter less than zero)  .............................................                  2
 3  Add lines 1 and 2; transfer this amount to the Computation of total sales or use tax due  
      section, line 1 on page 1  .....................................................................................................    3

Part 3 – Supplemental tax on vapor products
Compute the 20% supplemental use tax on all vapor products purchased when the supplemental sales tax has not been paid on retail 
purchases of vapor products. See instructions.
                                                                        A                       B                                                  C
                                                                 Purchase price or            Tax rate                                     Tax due on
                                                                   taxable receipts       on vapor products                                vapor products
                                                                   (see instructions)         (20% [.20])                                  (column A  ×column B)
                                                                                                .20
                                                                                                .20
 4  Total (add the Part 3, column C amounts; do not enter less than zero; transfer this amount to the  
      Computation of total sales or use tax due section, line 2 on page 1  ) ...................................................          4

Worksheet 2 – Nonbusiness-related purchases each costing $1,000 or more
Use this worksheet for nonbusiness-related purchases where each item or service costs $1,000 or more, excluding shipping and handling. 
Attach additional sheets if necessary. If any item or service costs $25,000 or more each, excluding shipping and handling, you must also 
complete Form IT-135, Sales and Use Tax Report for Purchases of Items and Services Costing $25,000 or More, and attach it to this form. 
When computing your tax due, you must include the shipping and handling charges in column A.
Note: Any unpaid sales or use tax on a motor vehicle, trailer, all-terrain vehicle, vessel or snowmobile that must be registered or titled by the 
New York State Department of Motor Vehicles is collected at the time of registration. Therefore, do not report or pay the sales or use tax on 
these items on this form.
               A                          B                        C                          D                                                    E
      Purchase price or          Combined state                  Tax                  Tax paid to another                                  Tax due
       taxable receipts           and local rate         (column A  ×column B)        taxing jurisdiction                                  (column C  -column D;
       (see instructions)           (from Chart 1;                                    (see instructions)                                   do not enter less than zero)
                                  see instructions)

 1  Total (add the column E amounts; do not enter less than zero; transfer this amount to the Computation
      of total sales or use tax due section, line 3 on page 1)  ......................................................................... 1

          44100212220094                                                                                                                                               (continued)



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                                                                                                                                         ST-141 (12/22)       Page 3 of 4
Worksheet 3 – Business-related purchases – Federal schedules (federal Schedule C and Schedule F 
                taxable business purchases, or federal Schedule E (Part I) taxable royalty
                or rental real estate activity-related purchases)
Part 1 – Purchases of clothing and footwear eligible for exemption
Clothing and footwear purchases under $110 per item or pair, excluding shipping and handling, are exempt from the 4% state sales tax, the ⅜% 
MCTD tax (in those localities that provide the less-than-$110 exemption), and some local taxes.
Chart 2 in the instructions lists the appropriate tax rate to enter for your locality in column B below. If your purchases qualify for both the state 
and local exemption, the rate will be 0. In this case, do not complete Part 1.
Report purchases of clothing and footwear costing $110 or more, and purchases of other taxable items or services, in Part 2 on page 3.
              A                          B                        C                         D                                                    E
     Purchase price or        Your sales and                      Tax                Tax paid to another                                 Tax due
     taxable receipts              use tax rate           (column A  ×column B)      taxing jurisdiction                                 (column C  -column D;
     (see instructions)            (from Chart 2;                                    (see instructions)                                  do not enter less than zero)
                              see instructions)

 1  Total (add the Part 1, column E amounts; do not enter less than zero)  ..................................................           1

Part 2 – All other taxable items and services
List all other taxable items or services, including taxable clothing and footwear each costing $110 or more, on which no New York State or local 
tax was collected from you at the time of purchase, or on which you owe additional local tax (see instructions). Shipping and handling charges 
must be included in column A when computing your tax due. Attach additional sheets if necessary. If any item or service purchased cost 
$25,000 or more each, excluding shipping and handling, you must also complete Form IT-135 and attach it to this form.
Note: Any unpaid sales or use tax on a motor vehicle, trailer, all-terrain vehicle, vessel, or snowmobile that must be registered or titled by the 
New York State Department of Motor Vehicles is collected at the time of registration. Therefore, do not report or pay the sales or use tax on 
these items on this form.
              A                          B                        C                         D                                                    E
     Purchase price or             Combined                       Tax                Tax paid to another                                 Tax due
     taxable receipts         state and local rate        (column A  ×column B)      taxing jurisdiction                                 (column C  -column D;
     (see instructions)            (from Chart 1;                                    (see instructions)                                  do not enter less than zero)
                               see instructions)

 2  Total (add the Part 2, column E amounts; do not enter less than zero)  ..................................................           2
  3  Add lines 1 and 2; transfer this amount to the Computation of total sales or use tax due  
       section, line 4 on page 1  ..................................................................................................... 3

Part 3 – Supplemental tax on vapor products
Compute the 20% supplemental use tax on all vapor products purchased when the supplemental sales tax has not been paid on retail 
purchases of vapor products. See instructions.

                                                                       A                       B                                                 C
                                                                  Purchase price or          Tax rate                                    Tax due on
                                                                  taxable receipts   on vapor products                                   vapor products
                                                                  (see instructions)         (20% [.20])                                 (column A  ×column B)
                                                                                               .20
                                                                                               .20
 4  Total (add the Part 3, column C amounts; do not enter less than zero; transfer this amount  
       to the Computation of total sales or use tax due section, line 5 on page 1)  .......................                             4

     44100312220094                                                                                                                                                  (continued)



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Page 4 of 4   ST-141 (12/22)
Worksheet 4 – Special tax on peer-to-peer car sharing
Compute the 6% special tax on peer-to-peer car sharing (see instructions) when the special tax has not already been paid on purchases of 
these services.
                                                                      A                    B                                            C
                                                              Taxable receipts             Tax rate on                          Tax due on
                                                                 (see instructions)        peer-to-peer car                     peer-to-peer car sharing
                                                                                           sharing (6% [.06])                   (column A  ×column B)
                                                                                           .06
                                                                                           .06
 1  Total (add column C amounts; do not enter less than zero; transfer this amount to the  
    Computation of total sales or use tax due section, line 6 on page 1  ) ................................................... 1

Certification: I certify that the above statements are true and correct, and I make these statements with the knowledge that willfully issuing a 
false or fraudulent document with the intent to evade tax may constitute a felony under New York State Tax Law, punishable by a substantial 
fine and a possible jail sentence. I also understand that the Tax Department is authorized to investigate the validity or the accuracy of any 
information entered on this document.
 Purchaser’s signature                                                                                                          Telephone number of purchaser

 Email address of purchaser                                                                                                     Date

 Printed name of preparer (if other than purchaser)                                                                             Preparer’s PTIN

 Signature of preparer (if other than purchaser)     Address of preparer

 Email address of preparer                                              Preparer’s telephone number                            Preparer’s NYTPRIN       Excl. Code

       44100412220094






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