Form Ta-1 - Application For Original Registration - 2002
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1
2Rev. 12/02
Massachusetts
Form TA-1
Department of
Application for Original Registration
Revenue
Check As Many As Apply
1. A 1.
Employer under the Income Tax Withholding Law (payroll tax)
D
Governmental or Charitable Exempt Purchaser
2.
Withholding for Pension Plans, Annuities and Retirement
E
Chapter 180 Organization Selling Alcoholic Beverages
Distributions
F
Use Tax Purchaser
B 1.
Sales/Use Tax on Goods Vendor
G
Boston Sightseeing Tour Surcharge
2.
Sales/Use Tax on Telecommunications Services Vendor
H
Boston Vehicular Rental Transaction Surcharge
3.
Meals Tax on Food and All Beverages
I
Parking Facilities Surcharge in Boston, Springfield
4.
Purchasing in MA for Out-of-State Resale Only
and/or Worcester
C
Room Occupancy Excise
J
Cigar and Smoking Tobacco Excise
Note: If you are selling cigarettes at retail, see instructions.
2.
3.
4.
Federal Identification number
Social Security number
No. of locations
Principal Place of Business
5.
Owner, partnership or legal corporate name
Name (cont’d.)
6.
Number and street
7.
8.
9.
City or town
State
Zip
—
10.
(Area code) Telephone number
(
)
—
General Information.
If a corporation, trust, association, fiduciary, or partnership — you must complete Schedule TA-3.
11. Indicate type of organization:
Corporation
Trust or association
Sole proprietor
Fiduciary
Partnership
Other (specify):
12. Indicate type of business:
Retail trade
Wholesale trade
Manufacturing
Construction
Governmental
Finance
Real estate
Service
Other (specify):
13. Describe nature of business:
14. Business activity code
15. Check applicable box:
Profit
Non-profit
16. If subsidiary corporation
Name of parent corporation
Federal Identification number
❿
17. If sole proprietor
Name of owner
Social Security number
(sole owner)
❿
18. Reason for applying:
Federal Identification number
Started new business
Purchased existing business — enter name, address, and Federal
Identification number of previous owner
Federal Identification number
Organizational change — Federal Identification number and close date of previous organization must be
entered, or application will be returned.
Other (attach explanation)
Mo
Day
Yr
Background Information
Close date:
19. Are any Massachusetts tax returns due or any Massachusetts taxes owed by your firm?
Yes
No. If yes, please explain:
20. Have you ever been issued a Certificate of Registration that was later revoked?
Yes
No. If yes, please explain:
Exempt Organizations
21. If you are applying for exempt purchaser status, be sure to include a copy of your IRS letter of exemption under Section 501(c)(3) of the Internal
Revenue Code. Subordinate organizations covered under an IRS group exemption letter should include a copy of the group exemption ruling and
a copy of the organization’s directory page listing the organization as an approved subordinate. Both of the questions below must be answered.
A. Are you exempt from paying U.S. income taxes?
Yes
No. B. Are you exempt from paying local property taxes?
Yes
No.
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