Department Of Taxation Nevada Commerce Tax Return Page 2
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1
2
3Taxpayer ID:
NV Business ID:
Tax Type:
COM
Correspon::lence ID:·
COMMERCE TAX ADDITIONAL INFORMATION FORM
Business entity legal name: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ FederallD Number: _ _ _ _ _ _ _ _
Business entity mailing address: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
NAlCS code (North America Industry Classification System) from _ _ _ _ _ _ _ _ _
List of owners, partners, corporate officers, managers, members, and authorized agents (attac!"" additional sheets if necessary):
Last, First, MI :
Residence Address (Street)
SSN:
Date of Birth
Title
~
--
--
----
~-~.---~.--~
..
--.---
..
~~-
--
Percen.t Owned
City, State, Zip +4
Residence Telephone
Last, First, MI :
Residence Address (Street)
SSN:
Date of Birth
Title
Percent Owned
City, State, Zip +4
Residence Telephone
Last. First. MI :
Residence Address (Street)
SSN:
Date of Birth
Title
Percent Owned
City, State. Zip
+4
Residence Telephone
Business is currently registered in Nevada for the following tax types:
,
o
Modified Business Tax
0
Sales/Use Tax
0
Consumer Use Tax
o
Certificate of Authority
D
Excise taxes (please list): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
TID number(s) for business currently registered in Nevada above: _ _ _ _ _ _ _ _ _ . _ _ _ _ _ _ _ _ _ _
o
I certify the information provided is true, correct and complete to the best of my knowledge and belief:
Taxpayers Signature
Printed Name and Title
Date
Phone Number
To complefe your Commerce Tax registration, sign and return to:
NEVADA DEPARTMENT OF TAXATION
Attn: Compliance Division
1550
College Parkway, Suite
115
Carson City, Nevada 89706-7937
If you need to register for other tax types in Nevada, please complete the Nevada Business Registration and
Supplemental Application forms located on the Department1s website:
I
FOR DEPARTMENT USE ONLY
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