Indiana Department of Revenue
Business Tax Application
Form BT-1
SF 43760
(Please print legibly or type the information on this application.)
(Revised 1-00)
A separate application is required for each business location.
Section A: Taxpayer Information (see instructions on page 1)
Contact the Department at (317) 615-2700 for more information regarding this application.
Federal
If this business is currently registered for
1.
2.
Identification
any Indiana tax under this ownership, enter
Number:
your Taxpayer Identification Number:
3.
Owner name, Legal name, Partnership name,
Corporate name or Other entity name:
If sole owner (Last name, First name, Middle Initial:
Mailing Address:
IN
City:
State:
Zip Code:
County:
4.
Check the type of organization of this business:
Sole Proprietor
Partnership
LLP
Corporation
LLC
Fed Govt
Other Govt
Other
5. All corporations answer the following questions: Otherwise, proceed to Question 6.
A. State of Incorporation:
B. Date of Incorporation:
C. State of Commercial Domicile:
Month
Day
Year
D. If not incorporated in Indiana, enter the
E. Accounting period
.
date authorized to do business in Indiana.
year ending date:
Month
Day
Year
Month
Day
6. Owner, Partners, or Officers (Attach separate sheet if necessary.)
Social Security Numbers are required in accordance with IC 4-1-8-1.
Social Security Number
Street Address
City
State
Zip Code
Last Name, First Name, Middle Initial
Title
7.
Name of contact person: (Person responsible for filing tax forms)
8.
Contact person's Daytime Telephone Number:
EXT
9.
Business trade name or DBA:
(This name and address is for the business location.)
Street Mailing Address:
(P.O. Box numbers cannot be used as a business location address.)
City:
State:
Zip Code:
County:
Township:
Tax District Number:(Motor Vehicle Rental only)
10. Business Location Telephone Number:
11.
North American Industry
Classification System (NAICS):
Please enter a primary and
P R I M A R Y
EXT
any secondary code(s) that
may apply.