Form Cd-3 Application For Meals & Rentals Tax Operators License
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1
2FORM
NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
CD-3
APPLICATION FOR MEALS & RENTALS TAX
055
OPERATORS LICENSE
FOR DRA USE ONLY
Collection Division, PO Box 454, Concord, NH 03302-0454
Mail To:
. Telephone No. (603) 271-2191.
License Number
LICENSE and FEIN/SSN REQUIRED BEFORE OPERATING
Date Issued
Be sure to read instructions on reverse side before filling out this form.
PLEASE TYPE OR PRINT CLEARLY
1
BUSINESS NAME
2
NAME OF ENTITY
3
MAILING ADDRESS
MAILING ADDRESS CONTINUED
4
5
CITY OR TOWN
ZIP CODE
STATE
Partnership
6(a)
Type of Legal Organization:
Proprietorship
Corporation
Fiduciary
Non-Profit
2
3
5
1
4
Single Member
Corporation
Partnership
Complete Either 6(a) or 6(b), but not both.
6(b)
LLC Taxed as:
1
2
3
(Do Not Enter SSN)
7
Federal Employer Identification Number of the above operation:
If you have not entered an FEIN at line 7 above, under what social security number or department identification number will your business taxes for
8
N L
this operation be filed? SSN:
or DIN:
9
List individual owner, partners or president and treasurer:
Name
Title
Social Security Number
Home Address
STREET ADDRESS
CITY/TOWN, STATE, ZIP CODE
STREET ADDRESS
CITY/TOWN, STATE, ZIP CODE
STREET ADDRESS
CITY/TOWN, STATE, ZIP CODE
10
Contact Person if other than above
Telephone # (
)
Ext.
NAME
TITLE
11
Business Telephone # (
)
Ext.
Home Telephone # (
)
12
Physical Business Address in NH
STREET, CITY and ZIP CODE
13
Proposed opening date
/
/
(Required)
14
Type of business activity
15
Check here if you serve....
Food
Alcoholic Beverages
Function
Motor
16
Check here if you rent........
Sleeping Accommodations. Number of Rooms
Rooms
Vehicles
17
Check here if you are requesting permission to file returns on a seasonal basis (less than twelve returns per year).
If yes what months will the business operate?
18
Prior business name
Prior Owner(s)
FOR DRA USE ONLY
I hereby certify that the above given information is true and correct and in conformity with applicable state laws.
x
SIGNATURE (IN INK) (REQUIRED ON ALL APPLICATIONS)
DATE
TITLE
DATE
Form CD-3
(11)
Rev. 10/1/06
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