Form S-1 App. and Instructions for Business Tax Account

1D Mailing Address: Date of 32 V S A 3260 Notice: / / Date you purchased business: / / (Please print) (Rev 6/04) (Street address only No PO Boxes) (Street address only No PO Boxes) 1A Type Check the box for the type of business ownership Sole Proprietor is a business owned by an individual a husband and wife or civil union members VT State Government includes Vermont state agencies municipalities and public corporations Partnership includes all partnership forms There is no separate category for general or limited partnership 501(c)(3) organizations please include a copy of your designation from the Internal Revenue Service If you have not received the 1B Name Print the name of the business Sole Proprietor the name of the person (or persons) who own the business Examples: John Smith Jack & Jill Hill Business the name of the business as it appears in the legal document forming the business Examples: ABC Corporation Good Partnership Smith & Smith LLC Edward Esquire PC Government Entities the name of the agencies and department 1B Name: 1C Identification Numbers 1C Identification Numbers: 1D Mailing Address Print the address where you want information mailed 1E Date authorized to do business in Vermont by Vermont Secretary of State This is the date of filing articles of association or received authorization to do business in this state State of Incorporation Enter the state where the business filed articles of association 1E Date authorized to do business in Vermont by Vermont Secretary of State: / / (For LLC S or C Corporation or Partnership) State of Incorporation: 1F Business Principals with Fiscal Responsibility 1F Business Principals with Fiscal Responsibility Print the title Social Security Number name and address of individuals who are responsible for the fiscal aspects of the business This may be partners president treasurer comptroller etc 1G Compliance Check 1G Compliance Check Check the appropriate Yes or No box to indicate whether any business principal has been involved with a compliance action by the Vermont Department of Taxes If Yes is checked include an explanation with the application Address Address Address Attach listing on separate piece of paper if more business principals APPLICATION FOR artisans selling at a craft fair in Vermont; operators of carnival rides Seasonal The business is open only during certain months of the year Indicate the months of operation Example: souvenir stand May June July August and September; cross country ski trails open December January February and March Business Activity List the business activities with the primary business activity first This information is used to make sure you have a tax account for all necessary taxes and to send notices of tax changes Business Activity List the business activities with the primary business activity first This information is used to make sure you have a tax account for all necessary taxes and to send notices of tax changes Business entities print your Federal Employer Identification Number (FEIN) Note: an employer regardless of ownership type must have a FEIN Sole proprietorship print the primary owner s social security number For husband and wife or civil union member owners use section 1F to provide the other individual s name and social security number Business Operation Check the appropriate box to indicate when the business is open This information determines when returns need to be filed Year Round The business is open for business in all months of the year Occasional The business makes few sales in Vermont and generally does not have a permanent location Example: out of state BUSINESS TAX ACCOUNT City of Montpelier VT Department of Education City/Town State ZIP Code City/Town State ZIP Code City/Town State ZIP Code Contact for Vermont Withholding Tax: Name Telephone number: Fax number: e mail address: D 501(c)(3) D Federal Government D VT State Government D Less than $2 499 D $2 500 $8 999 D $9 000 or more (requires EFT filing) D LLC D S Corporation D C Corporation D Other Government D Other D Sole Proprietor (Individual Husband/Wife or Civil Union owners) D Partnership designation yet include a copy of the organization s articles of association and bylaws Other Government includes agencies municipalities and public corporation from states territories or provinces other than Vermont Estimate of Annual Vermont Meals and Rooms tax liability Check the box for the amount of Vermont tax you estimate you will owe annually This information is used as a guide to determine how often the Meals and Rooms tax return must be filed Estimate of Annual Vermont Sales and Use tax liability Check the box for the amount of Vermont tax you estimate you will owe annually This information is used as a guide to determine how often the Sales and Use tax return must be filed Estimate of Quarterly Vermont Withholding tax liability Check the box for the amount of Vermont tax you estimate you will owe Example: ABC Corporation doing business as Trader Tim Examples: US Interior Department of National Parks Fax: (802) 828 5787 Federal Employer Identification Number Social Security Number (for Sole Proprietorship only) food vendor selling at a fair in Vermont Seasonal The business is open only during certain months of the year Indicate the months of operation Example: cremee stand open May June July August and September; concession at a ski area open December January February and March FOR DEPARTMENT USE ONLY Form S 1 from the one in Part 1D print here Physical Location of Business Print the street/road name city/town and state where the business is located Records Location Print the address where the tax records are kept if different from the one in Part 1D Federal Consolidated Group Print the name and FEIN of the parent corporation Fuel Gross Receipt Print the date the business started making sales of fuels subject to this tax Fuel Gross Receipts Start Date Full Legal Name of Proprietor (Last First Middle) Corporation Partnership etc Has the Vermont Department of Taxes required a bond for this business entity or any business entity in which any person listed above was an officer or held a 20% or more interest? D Yes (Attach explanation) D No Has the Vermont Department of Taxes suspended or revoked a Sales and Use or Meals and Rooms tax license for this business entity or any business entity in which any person listed above was an officer or held a 20% or more interest? D Yes (Attach explanation) D No I certify under pains and penalty of perjury this application is true correct and complete to the best of my John Smith doing business as Best Lawn Mowing Service knowledge Last Name First Name Middle Name Last Name First Name Middle Name Local Option Tax Print the date the business started making sales of items subject to this tax If doing business in multiple locations Local Option Tax(es) Start Date Local Option Town(s) Mailing Address for Corporate Income or Business Income (Entity) Tax account returns and information (if different from Part 1 address): Mailing Address for Meals and Rooms Tax account returns and information (if different from Part 1 address): Mailing Address for Sales and Use Tax Account If you want just the Meals and Rooms tax returns correspondence or other informa tion to go to an address different from the one in Part 1D print here Mailing Address for Sales and Use Tax Account If you want just the Sales and Use tax returns correspondence or other information to go to an address different from the one in Part 1D print here Mailing Address for Sales and Use Tax account returns and information (if different from Part 1 address): Mailing Address for Withholding Tax Account If you want just the Withholding tax returns correspondence or other information to go to an address different from the one in Part 1D print here Mailing Address for Withholding Tax account returns and information (if different from Part 1 address): Montpelier VT 05601 0547 Name and address of previous owner: Name Date Name of Filing Service used Print the name of the filing service if you use one Name of Filing Service used Print the name of the filing service if you use one Name of Payroll Service used (if any) Note: Buying an existing business requires notification to the Vermont Department of Taxes 10 days prior to the purchase If notice is not given you may become liable for the previous owner s outstanding business tax liability Note: For other than mobile vendors each business location is required to have its own tax account and license PART 1 APPLICANT INFORMATION 1A Type PART 2 Sales and Use Tax PART 3 Meals and Rooms Tax PART 4 Withholding Tax PART 5 Corporation Income Tax or Business Income (Entity) Tax Start Date This is the date the business started activity in Vermont Fiscal Year End Print the last day of the tax year Example: calendar year December 31; fiscal year June 30 Person to contact Print the name telephone number and other contact information Mailing Address for Tax Account If you want just the tax returns correspondence or other information to go to an address different PART 6 Other Taxes PART 7 Previous Ownership PART 8 Certification Person to contact about Vermont Corporate Income or Business Income (Entity) Tax account: Name Telephone number: Fax number: e mail address: Person to contact about Vermont Meals and Rooms Tax account: Name Telephone number: Fax number: e mail address: Person to contact about Vermont Sales and Use Tax account: Name Telephone number: Fax number: e mail address: Person to contact Print the name and contact information for someone the Department may call on questions about this tax account Person to contact Print the name and contact information for someone the Department may call on questions about this tax account Physical Location of Business Print the street/road name city/town and state where the business is located Note: A business may elect to have a master withholding tax account or a tax account for each location Physical Location of Business Print the street/road name city/town and state where the business is located This will be the address licensed to make sales For occasional businesses indicate the locations you will be making sales in Vermont For mobile vendors indicate various Example: 109 State Street Montpelier VT ; craft sales Manchester Essex Physical Location of Business Print the street/road name city/town and state where the business is located This will be the address licensed to make sales For occasional businesses indicate the locations you will be making sales in Vermont For mobile vendors indicate various Example: 109 State Street Montpelier VT food sales Manchester Essex Physical Location of Business: Physical Location of Business: PO Box 547 print the name of the local option town Please include city or town designation Examples: Manchester; Williston; Stratton quarterly This information is used as a guide to determine how often the Withholding tax return must be filed Note: Withholding of $9 000 or more per quarter are required to report and remit by electronic funds transfer (EFT) Please call or write for instructions Records Location: If part of a federal consolidated group enter the name and EIN of the parent If S Corporation include Form 2553 Reporting by: D Paper return D EFT Credit D EFT Debit Send or fax completed application to: Signature Title Start Date (see instructions) / / Business Operation: D Year Round D Occasional D Seasonal Months of Operation Estimate of annual Vermont Meals and Rooms tax liability: D $500 or less D Over $500 Name of Filing Service used (if any) Start Date (see instructions) / / Business Operation: D Year Round D Occasional D Seasonal Months of Operation Estimate of annual Vermont Sales and Use tax liability: D $500 or less D $501 $2 500 D Over $2 500 Name of Filing Service used (if any) Physical Location of Business: Start Date (see instructions) / / Estimate of Vermont Withholding tax liability per Quarter: Start Date (see instructions) / / Fiscal Year End Start Date This is the date the business started having payroll or making payments subject to Vermont income tax It may not necessar ily be the date the business started For out of state businesses the start date of Vermont activity Start Date This is the date the business started in Vermont to make sales of items subject to Meals and Rooms tax It may not necessarily be the date the business started For out of state businesses the start date is the date Vermont business started Start Date This is the date the business started in Vermont to make sales of items subject to sales tax or to make purchases subject to use tax It may not necessarily be the date the business started For out of state businesses the start date is the date Vermont business started Example: original business began July 1999 and sold services only In March 2001 the business expanded to sell items subject to sales tax The start date will be March 1 2001 State of Vermont Department of Forest & Parks Street Road or PO Box Street Road or PO Box City/Town State ZIP Code Street Road or PO Box City/Town State ZIP Code Telecommunications Print the date the business started making sales of telecommunication services subject to this tax Telecommunications Start Date Telephone: (802) 828 2551 The owner or business officer responsible for collection and remitting taxes is required to certify that the information provided in this application is true correct and complete Title SSN Name Title SSN Name Trade Name or d/b/a/ for this location: Brief description of business activity at this location (List in order of primary activity first) Trade Name or d/b/a/ for this location: Brief description of business activity at this location (List in order of primary activity first) Trade Name or Doing Business As (d/b/a) Name If you conduct business under a name other than indicated in Part 1B print the name Trade Name or Doing Business As (d/b/a) Name If you conduct business under a name other than indicated in Part 1B print the name here Example: ABC Corporation doing business as Trader Tim Trade Name or Doing Business As (d/b/a) Name If you conduct business under a name other than indicated in Part 1B print the name here Example: ABC Corporation doing business as Trader Tim John Smith doing business as Hot Diggity Doggity Food Cart TYPE OR PRINT Please read instructions and answer applicable questions completely VERMONT Vermont Department of Taxes VT ID NUMBER