Form Bt-1c - Application For Consolidated Tax Filing Number
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1Application for Consolidated
Form BT-1C
No Fee
State Form 48515
Tax Filing Number
Required
(R4 / 6-12)
Application for permission to report and remit
sales tax or food and beverage tax for the indicated business locations
on a consolidated return as provided in IC 6-2.5-6-3.
Please check the type of consolidated return you are requesting to fi le.
□
Sales Tax
□
Food and Beverage (Same County)
□
Food and Beverage (Same City/Same Town)
Select only one per BT-1C.
Please print or type all information. Contact the Department at (317) 233-4015 for more information regarding this application.
1.
Taxpayer Identif cation Number
2.
Federal Identif cation Number
____________________________________
____________________________________
TID# (10 Digits)
FID# (9 Digits)
3.
Name of contact person: (Person responsible for f ling tax forms)
4.
Contact person’s daytime telephone number:
5.
List all business locations for consolidated f ling. Attach additional sheet if necessary.
(P.O. Box numbers cannot be used as a business location address)
LOC #
Business Location Name
Street
City
State
ZIP Code
(3 Digits)
Signed: ___________________________________________________ Title: ______________________________ Date: ________________
Signature of owner, partner, corporate off cer, or resident agent
List additional names/locations on a separate sheet if necessary.
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