New York Change of Resident Status - Special Accruals

Change of Resident Status - Special Accruals
Form IT-260.1:9/15:Change of Resident Status -- Special Accruals:IT2601
Department of Taxation and Finance

Change of Resident Status –­ Special Accruals

IT-260.1
(9/15)

Tax Law – Sections 639 and 1307

Complete this agreement in triplicate and forward by registered mail
along with your securities, completed Form IT-201, IT-203, or IT-205,
and other required forms to the address shown on the right of this form.
If filing a joint return, use both names.

INCOME TAX AUDIT ADMINISTRATOR I
IFDAB
W A HARRIMAN CAMPUS
ALBANY NY 12227-4299

	
Whereas, I, (name)			
, of
(address as shown on return)		
,
have changed my status for New York State and/or New York City personal income tax purposes from that of a resident to
that of a nonresident on (date)	
, and

Whereas, I elect, pursuant to sections 639(a), 639(d), 639(e), 639(h), 1307(b), and 1307(e) of the Tax Law, to file my
New York personal income tax return for the period prior to my change of residence on the cash receipts basis, and

	

	
Whereas, the tax, as determined pursuant to sections 639(a), 639(d), 639(e), 639(h), 1307(b), 1307(c), 1307(e), and
1307(f) for the taxable year, or portion of the taxable year prior to my change of residence would have been increased by the
amount of $ 		
if such election had not been made, and
	Whereas, I hereby deposit with you the following described security:

	 1.	 Certificated U.S. Treasury bonds:
				
Registration or	
Par or 	
	
Due	
certificate number	
face value	

		

		

	

	

	

Market value

(as of date of filing with 		
Tax Department)

Attached and made part of this agreement is a properly completed U.S. Treasury Form PDF 1832, Special Form of
Assignment for U.S. Registered Definitive Securities, assigning said securities to the New York State Department of Taxation
and Finance.

	2.	 Certificated New York State bonds or bonds of any political subdivision thereof:

 

					 Market value
Registration or	
Par or 	
			
(as of date of filing with
	
Description	
Due	
certificate number 	
face value 	
Tax Department)

	

Attached and made part of this agreement is a properly completed New York State Form AU-217, Assignment Separate
from Bond, assigning said securities to the New York State Department of Taxation and Finance.

	3.	 Bank passbooks and/or certificates of deposit:
			
	
Bank/financial institution 	
Amount 	

	

If certificate of deposit,
maturity date

Attached and made part of this agreement is a letter prepared on the letterhead of the bank/financial institution and
signed by an officer thereof: a) identifying the passbooks or certificates of deposit by account number and confirming that
withdrawal of principal from the passbook or certificate of deposit will not be permitted without written consent from the New
York State Department of Taxation and Finance; and b) stating that any right of set-off which the bank/financial institution
may possess against the taxpayer resulting from a defaulted obligation of such taxpayer shall be subordinate to the interest
of the department in the passbook or certificate of deposit offered as collateral.

261001150094

IT-260.1 (9/15) (back)

	 4.	 Standby letter of credit:
	

	

Issuer or confirming bank	

Amount	

Expiration date

Attached and made part of this agreement is the irrevocable standby letter of credit made payable to the New York State
Department of Taxation and Finance.

	5.	 Form W-2G, Certain Gambling Winnings:
	

Attached and made part of this agreement is a copy of completed federal Form W-2G, which shows that New York State
taxes were withheld on the lottery payments.

			
Now, therefore, I agree that (1) I will include in my New York personal income tax returns in subsequent taxable
years (or periods) all income and gain accrued prior to my change of residence, as if I had not changed my resident status
and will pay the tax thereon when due; (2) the period of limitation within which tax may be assessed, set forth in Tax Law
section 683, is hereby extended as provided by paragraph (2) of subsection (c) of such section, and I hereby agree that
the tax due may be assessed for any taxable year (or periods) at any time within three years after the tax return relating
to the last taxable year during which income or gain accruing prior to my change of residence is actually received has
been filed; and (3) if the New York State Department of Taxation and Finance determines (a) that I have failed to include
in my New York personal income tax return for any taxable year (or period) any item of income or gain that is required
to be included therein under the terms of this agreement, or to pay any tax required to be paid, or (b) that the security
filed herewith has or will become inadequate to properly secure payment of the tax, the full amount of income which is
accruable under sections 639(a), 639(e), 639(h), 1307(b), 1307(c), 1307(e), and 1307(f) of the Tax Law shall be accrued
to the portion of the taxable year prior to the change of residence and the additional tax for such period, as recomputed,
shall become due immediately. If such tax is not paid within 30 days after notice of such determination described in
(a) above has been mailed to me by ordinary mail, or if the security that has been determined, as described in (b) above,
to be inadequate to secure payment of the tax is not replaced with adequate security acceptable to the department within
30 days after notice of such determination has been mailed to me by ordinary mail, the New York State Department of
Taxation and Finance may sell, assign, transfer, withdraw or otherwise dispose of said security and apply the proceeds to
any unpaid portion of the tax deferred by reason of the election and any interest and penalties due thereon. The balance of
such proceeds, if any, shall be paid to me.
			
The above described security is deposited with the understanding that: (1) in case no disposition is made
thereof under the terms of this agreement, such security will be returned to me at such time as the department determines
it is no longer needed as security by reason of the full or partial payment of the tax deferred as a result of the election
under sections 639(d), 639(h), 1307(b), 1307(c), 1307(e), and 1307(f); and (2) any interest accruing on said security shall
belong to me; and (3) in the case of certificated bonds, in coupon form, the coupons will be detached and forwarded to me
as they become due.

	Signature of taxpayer	
	Spouse’s signature (if joint return)

261002150094

Date