Department of Taxation and Finance

                              Instructions for Form AU-12                                                         AU-12-I(8/18)
                              Application for Credit or Refund of Sales or Use Tax – 
                              Qualified Empire Zone Enterprise (QEZE)

Caution: Your benefit period to claim QEZE credits may be expiring          Applicant information
soon. For more information, see TB-ST-730, QEZE Sales Tax Credit            Enter the address for the EZ location where the items or services are 
or Refund, and TSB-M-09(12)S, Changes to Qualified Empire                   being used. This may or may not be the main, or primary, address of the 
Zone Enterprises (QEZE) Program (Articles 28 and 29) – Effective            business.
September 1, 2009.
                                                                            If you are requesting a credit or refund for qualifying purchases made for 
                                                                            more than one EZ location, attach a list containing the addresses of all 
General information                                                         EZ locations included in this claim. 
Use Form AU-12 to apply for the QEZE credit or refund provided by Tax 
Law section 1119(d), effective for qualifying purchases made on or after    Claiming credit on a sales tax return
September 1, 2009.                                                          If you’re registered for New York State sales tax, you may report your 
                                                                            QEZE credit on your sales tax return (Schedule W) to offset sales tax 
Use Form AU-11, Application for Credit or Refund of Sales or Use Tax,       due. 
to claim
                                                                            •  If you’re applying part of your claim as a credit on Schedule W and 
•  a credit or refund based on purchases made before September 1,             requesting the balance as a refund, you must state these amounts 
2009, and                                                                     separately in the applicable boxes.
•  a credit or refund under Tax Law section 1119(a)(6) for tax paid on      •  If the sales tax due on your return is less than the credit claimed, you  
building materials used in construction, expansion, or rehabilitation of      must claim the remaining balance as a refund. You may not carry the  
real property located in an empire zone (EZ).                                 balance forward on future returns.  
For more information, see TSB-M-09(12)S, Changes to Qualified 
Empire Zone Enterprise (QEZE) Program (Articles 28 and 29) - Effective      Basis for claim
September 1, 2009.                                                          Mark an  Xin each appropriate box. 
You must attach all required substantiation and documentation or your       A – The property or service must be directly and predominantly (at least 
claim will not be processed. This includes:                                 50%) used or consumed by the QEZE in an EZ in which the QEZE has 
•  copy of the Certificate of Eligibility issued by Empire State            qualified for benefits. The credit or refund does not apply to purchases 
Development (ESD);                                                          of taxable food and drink (items such as sandwiches, heated food, 
•  copy of the Empire Zone Retention Certificate (EZRC) issued by ESD;      heated drink, or restaurant meals). The credit or refund also does not 
                                                                            apply to rent for hotel occupancy or charges for admission to a place of 
•  employment test worksheet:                                               amusement.
  –  Form AU-12.1, Employment Test for Businesses Certified by 
     Empire State Development (ESD) Before April 1, 2005                    B – The utility services must be directly and exclusively (100%) used or 
                                                                            consumed by the QEZE in an EZ in which the QEZE has qualified for 
  –  Form AU-12.2, Employment Test for Businesses Certified by Empire       benefits. This includes gas, electricity, refrigeration, and steam; and gas, 
     State Development (ESD) On or After April 1, 2005, and Before April 1, electric, refrigeration, and steam services of whatever nature.
     2009
  –  Form AU-12.3, Employment Test for Businesses Certified by              C – The telephony and telegraphy, telephone and telegraph services, or 
     Empire State Development (ESD) On or After April 1, 2009               telephone answering services must be delivered and billed to the QEZE 
•  documentation regarding your claim as described in Basis for claim       at an address in an EZ in which the QEZE has qualified for benefits.
•  invoices, receipts, proof of payment of tax, etc.                        D – The vehicle must be predominantly (at least 50%) used by the QEZE 
                                                                            in an EZ in which the QEZE has qualified for benefits. Predominant use 
                                                                            in EZs will occur if any one of the following conditions is met:
Who may file 
You may apply for a credit or refund of sales tax paid on qualifying        •  At least 50% of the vehicle’s use is exclusively in such zones.
purchases if you are a QEZE for sales and use tax purposes and you          •  At least 50% of the vehicle’s use is in activities originating or 
meet the criteria below.                                                      terminating in such zones.
If you were certified by ESD before April 1, 2009, you must have:           •  At least 50% of the vehicle’s use is a combination of use exclusively in 
                                                                              such zones and in activities originating or terminating in such zones.
•  applied for and received Form DTF-81, Qualified Empire Zone 
Enterprise (QEZE) Sales Tax Certification;                                  The QEZE may choose to compute the usage of the vehicle based 
•  received your EZRC from ESD; and                                         on either hours of use or miles traveled. This QEZE credit or refund 
                                                                            pertaining to motor vehicles also applies to the special taxes imposed 
•  passed the employment test for the tax year ending before the period     under Tax Law Article 28-A on passenger car rentals.
covered by this claim.
                                                                            E – Certain tangible personal property related to a motor vehicle; the 
If you meet these qualifications, you may use this form to claim a credit   motor vehicle must be used predominantly (at least 50%) by a QEZE 
or refund for tax paid on qualifying purchases.                             in an EZ in which the QEZE has qualified for benefits, as described in 
If you were certified by ESD on or after April 1, 2009, you must have:      box D. Examples of tangible personal property related to a motor vehicle 
                                                                            include a battery, an engine, engine components, a muffler, tires and 
•  received your EZRC from ESD; and                                         similar tangible personal property used in or on a motor vehicle.
•  passed the employment test for the tax year ending before the period 
covered by this claim.                                                      Employment test
If you meet these qualifications, you may use Form AU-12                    You must pass an employment test at the end of every tax year 
to claim a credit or refund for tax paid on qualifying purchases,           (calendar or fiscal) to determine if you qualify for QEZE sales tax 
but only if the qualifying purchase is made in a locality that has elected  benefits for the next tax year. The effective date from your Certificate 
to provide the credit. For more information, see Publication 718-QZ, 
Qualified Empire Zone Enterprise (QEZE) Sales and Use Tax Refund 
Rates. 

Page 2 of 2 AU-12-I (8/18)

of Eligibility (issued by ESD) determines which worksheet you need to        •  If the invoices and credit memoranda to be submitted are voluminous, 
include.                                                                      submit a schedule or a summary in table form. The schedule or 
•  Form AU-12.1, if you were certified by ESD before April 1, 2005            summary should contain all pertinent information concerning these 
                                                                              documents, such as invoice number, date of invoice, name of 
•  Form AU-12.2, if you were certified by ESD on or after April 1, 2005,      purchaser or supplier, item sold or purchased, amount of invoice 
   and before April 1, 2009                                                   excluding tax, amount of tax billed, taxing jurisdiction where sale 
•  Form AU-12.3, if you were certified by ESD on or after April 1, 2009       or purchase was made, and the reason the applicant is entitled to 
                                                                              a credit or refund. We may request documentation to verify any 
If you were certified before April 1, 2009,complete the employment test       schedule or summary that you submit.
using your base period information from your application for QEZE sales 
tax certification filed with the Tax Department (Form DTF-80, Application    •  The supporting documents should include the vendor’s name and 
for a Qualified Empire Zone Enterprise (QEZE) Sales Tax Certification;        address. If they don’t, or if the transaction took place somewhere 
Form DTF-82, Application for a Qualified Empire Zone Enterprise               other than the vendor’s address, you must:
(QEZE) Sales Tax Certification – For businesses certified by Empire            –  include the vendor’s name and location;
State Development before August 1, 2002; Form DTF-83, Application for          –  include the location where the transaction took place (generally, 
a Qualified Empire Zone Enterprise (QEZE) Sales Tax Certification – For           where you took title or possession); and
businesses certified by Empire State Development on or after August 1,         –  include the invoices showing the tax you paid.
2002, and before April 1, 2005; or Form DTF-84, Application for a 
Qualified Empire Zone Enterprise (QEZE) Sales Tax Certification – For 
businesses certified by Empire State Development on or after April 1,        Representative 
2005, and before April 1, 2009).                                             If an outside individual or firm prepared the application (not the applicant 
                                                                             or the owner, partner or an officer of the business listed as the applicant) 
If you have more than one EZ location, use the effective date from your      the name and address should be included under Representative’s 
first (earliest) Certificate of Eligibility to determine which worksheet you name and Representative’s mailing address. The representative’s 
need to file.                                                                signature and the identification number of the firm should be included 
You must complete and pass the employment test using your                    under Representative’s signature and Representative’s ID number. 
employment numbers for the tax year ending before the period covered         The representative must file a properly completed Form POA-1, Power 
by this application to qualify for the credit or refund being claimed. Once  of Attorney, authorizing him/her to act on the applicant’s behalf and to 
you have completed the employment test worksheet for a tax year,             receive information pertaining to the application for credit or refund. 
attach a copy of that worksheet to any subsequent claim for credit or        Form POA-1 is available on our Web site (see Need help?).
refund to which that employment test applies.
If your credit or refund claim covers periods from more than one tax year,   When to file your application
you must complete and attach employment test worksheets for each tax         Generally, you must submit your application within three years from the 
year required.                                                               date the tax was payable to the Tax Department, or two years from the 
                                                                             date the tax was paid, whichever is later. You may file this form only 
Example: A business was certified by ESD with an effective date of           once each sales tax quarter.
February 15, 2008, on its Certificate of Eligibility. The business applied 
for and received QEZE sales tax certification from the Tax Department        Where to file your application
effective October 1, 2008. The business files taxes on a calendar year 
basis.                                                                       Mail your completed application and all required substantiation and 
                                                                             documentation to:
At the end of December 2008, the business completed the employment test                    NYS TAX DEPARTMENT
for the 2008 tax year (January through December 2008) and determined that                  TDAB – SALES TAX REFUNDS              
it qualifies for QEZE sales tax benefits for 2009.                                         W A HARRIMAN CAMPUS
                                                                                           ALBANY NY 12227-9364
At the end of December 2009, the business completed the employment test 
for the 2009 tax year (January through December 2009) and determined that    If not using U.S. Mail, see Publication 55, Designated Private Delivery 
it qualifies for QEZE sales tax benefits for 2010.                           Services.
In March 2010, the business files Form AU-12 to claim a refund of 
tax paid on qualifying purchases made during September through 
December 2009 and for January through February 2010. When                     Need help?
filing Form AU-12 to claim the refund, it must complete and attach 
Form AU-12.2 for the 2008 tax year to support its claim for a refund                      Visit our website at www.tax.ny.gov
for the September through December 2009 period, and Form AU-12.2                          •  get information and manage your taxes online
for the 2009 tax year to support its claim for a refund for the January 
through February 2010 period.                                                             •  check for new online services and features

In June 2010, the business files Form AU-12 to claim a refund of tax          Telephone assistance
paid on qualifying purchases made during March through May 2010. 
When filing Form AU-12 to claim the refund, it must attach a copy of its      Sales Tax Information Center:                       518-485-2889
Form AU-12.2 for the 2009 tax year to support the refund claimed.
                                                                              To order forms and publications:                    518-457-5431
Documentation                                                                 Text Telephone (TTY) or TDD                         Dial 7-1-1 for the  
•  Explain the basis for the credit or refund claim in detail and send          equipment users                          New York Relay Service
   legible copies of all supporting documents (for example: invoices, 
   receipts, proof of payment of tax, etc.).
•  Your documents must be in a format that allows the Tax Department         Privacy notification 
   to determine the correct jurisdiction and amount for each credit          New York State Law requires all government agencies that maintain a 
   or refund claimed. Cash receipts, register tapes, or other forms of       system of records to provide notification of the legal authority for any 
   receipts or invoices that don’t identify the purchaser may not be         request for personal information, the principal purpose(s) for which the 
   accepted.                                                                 information is to be collected, and where it will be maintained. To view 
•  Your documents must contain the address of the business receiving         this information, visit our website, or, if you do not have Internet access, 
   the property or services.                                                 call and request Publication 54, Privacy Notification. See Need help? for 
•  If your form is incomplete, or if you don’t provide necessary supporting  the Web address and telephone number.
   documents, we may deny your application.