Page I
Office use only
Comptroller of Maryland
Combined Registration Application
See instructions on page IV
SECTION A: All applicants must complete this section.
8. Type of registration: must check appropriate box(es)
1a) Federal Employer Identification Number (See instructions)
Number if registered:
–
K
AND
a.
Sales and use tax
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
K
b.
Sales and use tax exemption
b) Social Security number of owner, officer or agent responsible
for nonprofit organizations
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
for taxes (must be supplied and is required by law)
K
c.
Tire recycling fee
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
–
–
K
d.
Admissions & amusement tax
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
K
2. Legal name of dealer, employer, corporation or owner
e.
Employer withholding tax
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
K
f.
Unemployment insurance
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
K
g.
Alcohol tax
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
3. Trade name (if different from above)
K
h.
Tobacco tax
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
K
i.
Motor fuel tax
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
4. Street Address of physical business location (P.O. box not acceptable)
K
j.
Transient vendor license
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
9.Type of ownership: (Check appropriate box)
City, County, and State
ZIP code
(nine digits if known)
K
K
a.
Sole proprietorship
e.
Limited liability company
K
K
b.
Partnership
f.
Non-Maryland corporation
K
K
c.
Nonprofit corporation j.
Governmental
K
K
K
Telephone number
( _ _ _ _ _ _ _ _ _) _ _ _ _ _ _ _ _ _ - _ _ _ _ _ _ _ _ _ _ _ _
d.
Maryland corporation k.
Fiduciary l.
Business trust
Fax number
( _ _ _ _ _ _ _ _ _) _ _ _ _ _ _ _ _ _ - _ _ _ _ _ _ _ _ _ _ _ _
10. Date first sales made in
11. Date first wages paid in
Maryland:
Maryland subject to withholding:
E-mail address _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
5. Mailing address (P.O. box acceptable)
12. If you currently file a
13. If you have employees enter
consolidated sales and
the number of your workers’
use tax return, enter the
compensation insurance policy
number of your account:
or binder:
City, State
ZIP code
(nine digits if known)
14. (a) Have you paid or do you anticipate pay-
15. Number of
ing wages to individuals, including corporate
employees:
K
6. Reason for applying:
Reopen/reactivate
officers, for services performed in Maryland?
K
K
K
K
New business
Additional location(s)
Yes
No (b) If yes, enter date
K
K
Merger
Purchased going business
K
K
wages first paid _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Change of entity
Remit use tax on purchases
K
K
Reorganization
Other (describe)
16. Estimated gross wages
17. Do you need a sales and use
paid in first quarter of
tax account only to remit
7. List previous owner’s name, address and telephone number:
operations:
taxes on untaxed purchases?
K
K
Yes
No
18. Describe for profit or nonprofit business activity that generates revenue. Specify the product manufactured and/or sold, or the type of
service performed.
K
K
19. Are you a nonprofit organization applying for a sales and use tax exemption certificate?
Yes
No
If yes, See Instruction 8b.
Failure to enclose a non-returnable copy of IRS determination letter, articles of incorporation, bylaws, and other organization documents
as described in the instructions will result in your application being returned.
20. Does the business have only one physical location in Maryland? (Do not count client sites or offsite projects that will last less than one
K
K
year.)
Yes
No Specify how many _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
21. Identify owners, partners, corporate officers, trustees, or members: (Please list person whose Social Security number is listed in Section A.1b first.)
*Nonprofit Organization applying for sales & use tax exemptions must identify at least two owners, partners, corporate officers, trustees or
members.
Name and Social Security number
Title
Home address, city, state, ZIP code
Telephone number
Rev. 09/09