Form Ap-100-2 - Sales Tax Permit/use Tax Permit/mixed Beverage Tax Account Set-Up Page 3
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1
2
3AP-100-4
(Rev. 10-93/14)
TEXAS APPLICATION
Page 3
• SALES TAX PERMIT
• USE TAX PERMIT
• MIXED BEVERAGE TAX ACCOUNT SET-UP
34. Legal name of owner (Sole owner, partnership, corporation or other name)(Same as Item 1)
If you purchased an existing business or business assets, complete Items 35-38. If you did not, skip to Item 39.
For Comptroller’s Use Only
35. Enter the former owner's trade name. If known, enter the former owner's Texas taxpayer number.
Trade name
Taxpayer number of former owner
OF
NR
36. Enter the former owner's legal name. If known, enter the former owner's telephone number.
Former owner
Legal name of former owner
Phone (Area code & no.)
Active
Address of former owner (Street & number, city, state, ZIP code)
OOB
37. Check each of the following items you purchased. (This includes the value of stock exchanged for assets.)
Inventory
Corporate stock
Equipment
Real estate
Other assets
TCB attached
38. Enter the purchase price of the business or assets purchased and the date purchased.
Purchase price
Date of purchase (Mo., day, year)
TCR previously
$
submitted
Date of application (Mo., day, year)
The sole owner, all general partners, corporation president, vice-president, secretary or treasurer or an authorized
representative must sign this application. Representative must submit a written power of attorney with application.
(Attach additional sheets, if necessary.)
39. I (We) declare that the information in this document and any attachments is true and correct to the best of my (our) knowledge and belief.
Type or print name and title of sole owner, partner or officer
Sole owner, partner or officer
sign
here
Type or print name and title of partner or officer
Partner or officer
sign
here
Type or print name and title of partner or officer
Partner or officer
sign
here
YOUR PERMIT MUST BE PROMINENTLY DISPLAYED IN YOUR PLACE OF BUSINESS. THE INFORMATION ON YOUR PERMIT IS PUBLIC
INFORMATION.
No. ____________________________ Date ____________________
To expedite the receipt of your permit, complete this application
and mail to your nearest
E.O. name _______________________ Destin ___________________
COMPTROLLER'S FIELD OFFICE
Bond amount _____________________________________________
Type of bond
LOA
LOC
Surety
Cash
COMPTROLLER OF PUBLIC ACCOUNTS
T Code PYHOLD verified
111 E. 17th Street
Austin, Texas 78774-0100
FALCON entered by _ _ _ _
________________________________
FOR COMPTROLLER'S USE ONLY
JURISDICTION CODES
0 - Outside jurisdiction limits, NO TAX
1 - Outside jurisdiction limits, LIST
2 - Inside jurisdiction limits, OUTLET
3 - Inside jurisdiction limits, OUTLET LONG
4 - Inside jurisdiction limits, LIST
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Parent category: Financial