Fillable Form 40003 - Oklahoma Retail Fireworks Registration Application (Page 2 of 4) in pdf

Form 40003 - Page B

Oklahoma Retail Fireworks Registration Application

For multiple locations,

indicate the number

Business Name: ____________________________________________________________________

of copies attached:

(same as Part 5, Item 1)

FEIN/SSN: _________________________________________________________________________

Part 5 - Physical Location and Classification Information:

1. Trade Name of Business (DBA): ________________________________________________________________

2. (a) Physical Location of Fireworks Stand: _________________________________________________________

Street and Number or Directions (Do not use post office box or rural route number)

__________________________________________________

_____

_____________

_____________________________________

City

State

Zip

County

(b) Is the physical location of the business inside the city limits? ........................................................

Yes

3. Entity Phone ( ____ ) ___________________________

Entity Fax ( _____ ) __________________________

Entity Email: ________________________________________________________________________________

4. Are all the sales made inside the city limits of the city listed above? ..................................................

Yes

......................................

5. Are all the sales made inside the county limits of the county listed above?

Yes

Part 6 - Sales and Use Tax:

1. If you currently hold or have previously held an Oklahoma Sales Tax Permit please list number(s):

Sales Tax: _______________________________________

Sales Tax: ______________________________________

Sales Tax: _______________________________________

Sales Tax: ______________________________________

Sales Tax: _______________________________________

Sales Tax: ______________________________________

...........................

______ / _______/ ______

2. Date of first sales subject to sales in Oklahoma

(month/day/year)

Part 7 - Signature:

A sole owner, general partner, corporate officer or authorized representative must sign this application.

I, the undersigned applicant or authorized representative, declare under the penalties of perjury that I have examined this application and attachments and, to the best of

my knowledge, the facts set forth are true and correct, and that the requirements hereunder will be carried out in accordance with the laws of the State of Oklahoma and

the rules and regulations of the Oklahoma Tax Commission. I further acknowledge and agree that withholding taxes are trust funds for the State of Oklahoma and that

any use of these trust funds other than timely remittance to the State of Oklahoma is embezzlement and can result in criminal prosecution.

_______________________________________________________________________

___________________________________________

_____________

Type or print name and title

Signature

Date

Mandatory inclusion of Social Security and/or Federal Employer’s Identification Numbers are required on forms filed with the Oklahoma Tax Commission pursuant to Title

68 of the Oklahoma Statutes and regulations thereunder, for identification purposes, and are deemed part of the confidential files and records of the Oklahoma Tax Com-

mission. The Oklahoma Tax Commission is not required to give actual notice of changes in any state tax laws.

Part 8 - Fees:

Notice: All registrations and license fees must be paid with the Business Registration Application. Failure to

include the fees will delay processing of your application. Refer to the “Instructions and Definitions” on Page

D of this application for further information regarding fees.

Please check ( ✓ ) the appropriate box(es) for each license and/or permit that you are applying for and enter the ap-

plicable fee amount in the “Total” column at the far right.

License or Permit Type

Basic Fee (each)

Tax Code

Total

1. Retail Fireworks Sales Tax Permit .............................. $ 20.00 .......................STP ........... $ _____________.00

2. Retail Fireworks Sales Tax Permit for Additional Locations:

(Number of Locations _________________ ) @ $ 10.00 .......................STP ........... $ _____________.00

Make Checks Payable to: Oklahoma Tax Commission. TOTAL AMOUNT DUE ....................... $ _____________.00

Mail to: Oklahoma Tax Commission - Post Office Box 26920 - Oklahoma City, OK 73126-0920

Form 40003 - Oklahoma Retail Fireworks Registration Application Page 2

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