Department of Taxation and Finance                                                          Quarterly Schedule W
                     Report of Purchases Eligible                                            File as an attachment to Form ST-100
                     for Credit by a Qualified                                              For 2nd quarter tax period: 
                                                                                            June 1, 2021, through August 31, 2021                            W
                     Empire Zone Enterprise                                                                                                                  Include with   
                     (QEZE)                                                                 Due date:                                                        Form ST-100
                                                                                            Monday, September 20, 2021
                                                                                                                                                             222
 Sales tax identification number                            Legal name (Print ID number and name as shown on Form ST-100 or Certificate of Authority)

Caution: Your benefit period to claim QEZE credits may be expiring soon. See instructions for more information.
If you were certified by Empire State Development (ESD) on or after April 1, 2009, you may use this schedule only if you made purchases 
in the following jurisdictions (see instructions on page 2): Allegany County, Cayuga County, city of Auburn, Erie County, Herkimer County, 
Montgomery County, and Niagara County.
Note: You must also complete Form AU-12, Application for Credit or Refund of Sales or Use Tax–Qualified Empire Zone Enterprise (QEZE), 
and mail it to the address shown on Form AU-12-I, Instructions for Form AU-12, when you take credits on this schedule.
Do not use this form to claim a credit for the tax paid on qualifying purchases of motor fuel or diesel motor fuel. You must use Form FT-500, 
Application for Refund of Sales Tax Paid on Petroleum Products.

 Part 1 – Verify eligibility

Empire zone certification number from your Empire Zone Retention Certificate (EZRC)  

If you were certified by ESD before April 1, 2009, you must have applied for and received Form DTF-81-PC, Qualified Empire Zone 
Enterprise (QEZE) Sales Tax Certification, before claiming credits.
Has your business passed the employment test for the tax year ending before the period covered by this schedule to 
verify that it is eligible to claim the QEZE credit for this reporting period? (If so, you must mark an X in the box. 
If not, stop; you are not eligible for the QEZE credit. Do not file this schedule.) ............................................................................................

 Part 2 – Purchases eligible for credit by jurisdiction – Enter amounts of purchases eligible for credit on the appropriate 
 jurisdiction line. Only the local jurisdictions listed below are eligible for a credit of local sales tax. If a purchase was made in a local 
 jurisdiction not listed below, enter the amount on either the New York State only line or the New York State/MCTD line, as applicable. 
 Note: Only businesses certified by ESD before April 1, 2009, are allowed to claim credits on the New York State only line or the New York 
 State/MCTD line.
                 Column A                         Column B                                  Column C                    Column D                     Column E
                 Taxing jurisdiction              Jurisdiction                              Eligible purchases          × Tax rate = Amount of sales and use tax credit
                                                       code                                                                                          (C × D)
 New York State only                      NE  W0021                                                              .00      4%
 New York State/MCTD                      NE  W8061                                                              .00  4⅜%
 Allegany County                                  AL  W0221                                                      .00  8½%
 Cayuga County                            CA  W0511                                                              .00      8%
   Auburn (city)                          AU  W0561                                                              .00      8%
 Erie County                              ER  W1451                                                              .00  8¾%
 Herkimer County                          HE  W2121                                                              .00  8¼%
 Montgomery County                        MO  W2781                                                              .00      8%
 Niagara County                                   NI  W2911                                                      .00      8%

                                          Column totals:                                                         .00
                                                                   Include this amount as a negative                                  Include this amount as 
                                                               on Form ST-100, page 2, Column D, in                                  a negative on Form ST-100, 
                                                               box 4.                                                                page 2, Column F, in box 5. (See 
                                                                                                                                     instructions on page 2.)

                                                                                                                                                     ST-100

                                                                                                                                      Insert Form ST-100.1
                                                                                                                                       inside Form ST-100
        50100108210094                                                                                                                                       W

                                                                                                                                    ST-100.1 (6/21)  Page 1 of 2

                                                                           Report of Purchases Eligible for Credit by 
      Quarterly Schedule W 
                                                                           a Qualified Empire Zone Enterprise (QEZE)
                                   Instructions                            Report transactions for the period June 1, 2021, through August 31, 2021.

Caution: Your benefit period to claim QEZE credits may be expiring         Employment test – You must complete and pass the employment test 
soon. For more information, see TB-ST-730, QEZE Sales Tax Credit           using your employment numbers for the tax year ending before the 
or Refund, and TSB-M-09(12)S, Changes to Qualified Empire                  period covered by Form AU-12 to qualify for the credit.  
Zone Enterprise (QEZE) Program (Articles 28 and 29) – Effective            If your credit or refund claim covers periods from more than one tax year, you 
September 1, 2009.                                                         must complete the employment test for each tax year required.
                                                                           Example: A business was certified by ESD with an effective date of 
Who may file                                                               February 15, 2009, on its Certificate of Eligibility. The business applied 
Complete and file Form ST-100.1, Quarterly Schedule W, if you file         for and received QEZE sales tax certification from the Tax Department 
Form ST-100, New York State and Local Quarterly Sales and Use Tax          effective October 1, 2009. The business files taxes on a calendar year 
Return, you made purchases eligible for the qualified empire zone          basis.
enterprise (QEZE) sales and use tax credit, and you want to claim the 
credit against the sales and use tax you owe with this return.             At the end of December 2016, the business completed the employment 
                                                                           test for the 2016 tax year (January through December 2016) and 
If you are taking credits on this schedule, you must also complete         determined that it qualifies for QEZE sales tax benefits for 2017.
Form AU-12, Application for Credit or Refund of Sales or Use 
Tax – Qualified Empire Zone Enterprise (QEZE), and mail it to the          At the end of December 2017, the business completed the employment 
address shown on Form AU-12-I, Instructions for Form AU-12. Do not         test for the 2017 tax year (January through December 2017) and 
attach Form AU-12 to this return.                                          determined that it qualifies for QEZE sales tax benefits for 2018.
The application must state that the credit has been claimed on a           In March 2018, the business files Form ST-100.1, to report a credit 
sales tax return and the period covered by that return. Supporting         for tax paid on qualifying purchases made during September through 
documentation must be filed with Form AU-12.                               December 2017 and for January through February 2018.
If you were certified by Empire State Development (ESD) before             When filing Form AU-12 to claim the credit, it must complete and 
April 1, 2009, you must have:                                              attach employment test worksheets for the 2016 tax year to support its 
                                                                           claim for a credit for the September through December 2017 period, 
•  applied for and received Form DTF-81-PC, Qualified Empire Zone          and for the 2017 tax year to support its claim for the January through 
 Enterprise (QEZE) Sales Tax Certification;                                February 2018 period.
•  received your Empire Zone Retention Certificate (EZRC) from ESD; 
 and                                                                       Mark an  Xin the box if your business has passed the employment test for 
                                                                           the tax year ending before the period covered by this schedule to verify 
•  passed the employment test for the tax year ending before the period    that it is eligible to claim the QEZE credit. If not, stop; you are not eligible 
 covered by this schedule.                                                 for the QEZE credit. Do not file this schedule.
If you meet these qualifications, you may use this schedule to claim a 
credit for tax paid on qualifying purchases.                               Part 2 – Purchases eligible for credit by jurisdiction
If you were certified by ESD on or after April 1, 2009, you must have:     Column C – Eligible purchases – Enter in Column C your purchases 
                                                                           eligible for credit on the appropriate jurisdiction line.
•  received your EZRC from ESD; and
•  passed the employment test for the tax year ending before the period    If you were certified by ESD before April 1, 2009, use the jurisdiction 
 covered by this schedule.                                                 line for the locality where the purchase was made. If a purchase was 
                                                                           made in a local jurisdiction that is not listed, enter the amount on either 
If you meet these qualifications, you may use this schedule to claim       the New York State only 4% line or the New York State/MCTD 4⅜% 
a credit for tax paid on qualifying purchases, but only if the qualifying  line, as applicable.
purchase is made in a locality that has elected to provide the credit. The 
following localities are currently eligible:                               If you were certified by ESD on or after April 1, 2009, credit is 
                                                                           only allowed if the jurisdiction has elected to provide this credit 
 Allegany County                                                           (Allegany County, Cayuga County, city of Auburn, Erie County, 
 Cayuga County                                                             Herkimer County, Montgomery County and Niagara County). If the 
 Auburn (city)                                                             locality has not made this election, no credit of any taxes (State, MCTD 
 Erie County                                                               and local) is allowed. Do not make any entries on either the New York 
 Herkimer County                                                           State only 4% line or the New York State/MCTD 4⅜% line.
 Montgomery County
 Niagara County                                                            Column E – Amount of sales and use tax credit – For each jurisdiction, 
                                                                           multiply the amount in Column C by the tax rate in Column D, and enter 
If the locality where you made the purchase is not listed as an            the resulting credit amount in Column E. After entering information for all 
eligible locality, no credit of any taxes (State, Metropolitan Commuter    jurisdictions required, separately total Columns C and E. Include the column 
Transportation District (MCTD) or local) is available.                     totals on Form ST-100 as instructed.

Specific instructions                                                      Filing this schedule 
Identification number and name – Print the sales tax identification        File a completed Form ST-100.1 and any other attachments with 
number and legal name as shown on Form ST-100 or on your                   Form ST-100 by the due date. Be sure to keep a copy of your 
business’s Certificate of Authority for sales and use tax.                 completed return for your records.

Part 1 – Verify eligibility                                                Need help? and Privacy notification 
EZRC number – Print the empire zone certification number from your         See Form ST-100-I, ST-100 Quarterly Instructions.
EZRC issued by ESD.

      50100208210094

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