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Signature
I acknowledge that all e-file ATS tests submitted during the approval process are
created in and originate from the actual software.
I acknowledge that all electronic returns received by New York State generated from
this software will be electronically filed from the initially approved product version, or a
subsequent product update.
I acknowledge that New York State will be notified immediately of any incorrect and/or
missing calculation or e-file data element for any electronically filed returns submitted
to New York State
As the representative of the above named organization, I agree, on behalf of the organization,
to comply with all requirements listed above. Furthermore, by signing this agreement, my
organization is agreeing to all of the requirements listed above. The New York State
Department of Taxation and Finance reserves the right to revoke approval acceptance of any
company and thereby refuse to accept any additional returns from such software company
that does not adhere to above stated requirements.
As an approved New York State provider, I agree to provide true, accurate, current, and
complete information about my company. I understand that if I provide any information that is
untrue, inaccurate, obsolete, or incomplete, the New York State Department of Taxation and
Finance has the right to deny, suspend, or terminate my account.
(AUTHORIZED REPRESENTATIVE)
PRINTED NAME
(AUTHORIZED REPRESENTATIVE)
SIGNATURE
TR-376-FIDMEF (10/17) Page 6 of 6
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