New York State Dew ant of Taxation and Finance Purchaser's Report of Sales and Jse Tax ST-130 (7/00) Do not use this form if you are required to register as a vendor with the New York State Tax Department or are reporting the purchase of a motor vehicle, snowmobile, vessel, or all-terrain vehicle that must be registered or titled by the Department of Motor Vehicles. Type or print clearly FuN name past and rust) Social security number p BLACK. B. COHEN & J. HANNAN TRUSTEES FBO ALEXANDER BLACK(11/30132) Home address (number and street or rural route) Federal identification number or any) do J. HANNAN, TTEE City, village, or post office State ZIP code Business name and address, if different from above For office use only Location code Tax jurisdiction code Taxable sales Sales and use tax Part I — Summary the 1 2 of purchases — If you are reporting the purchase of more than information requested on lines 1 through 12 for each item or service. Item purchased or service rendered K furniture K furs ❑jewelry Date brought into New York State Jul. 11, 2000 (see one item or service, attach a list showing • ri D utility gas U other (identify) 1/4 interest art work and electricity in:nth:ma) Georges Seurat: "Le Chien Noir" 3 Method of delivery K purchaser pick up D US Postal Service El UPS K seller's vehicle Q other (identily)Private carrier 4 Location where item was delivered City New York County New York State NY 5 Location where item is used City New York County New York State NY 6 Sellers name and address Kat rin Bellinger, Munich City State Part II — Summary of taxes due 7 Amount subject to sales or compensating use tax (see instructions) 7 318,750 8 Tax rate applicable where item was delivered 8 8.25 9 Tax rate applicable where item is used 9 10 Tax due (multiply line 7 by Mw 8 or 9: see insfructiDns) 10 26,296. 38 11 Amount of sales tax paid (if any) to: • City County State 11 12 Total New Y