Form Bt-1 - Business Tax Application - 2014
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1
2
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4Form BT-1
Indiana Department of Revenue
State Form 43760
Business Tax Application
(R11 / 8-14)
A separate application is required for each business location.
To file this application online, visit:
https://secure.in.gov/apps/dor/bt1
Section A: Taxpayer Information (see instructions on page 1)
Visit
INTax.in.gov
to file and pay your business taxes online.
Please print legibly or type the information on this application.
2.
If this business is currently registered with the Department of Revenue,
Federal Identification Number (FID):
1.
enter your Taxpayer Identification Number (TID):
___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___
___ ___
___ ___ ___ ___ ___ ___ ___
3. Name of contact person responsible for filing tax forms.
4.
Contact person’s daytime telephone number:
(
)
A
B
EXT
C
5. Check (only one) reason for filing this application:
A
Starting New Business
B
Business Under New Ownership
To Change Type of Organization
D
E
To Add Location to Existing Account
To Register for Other Type(s) of Tax
F
Other
Owner name, Legal name, Partnership name, Corporate name or
7.
6.
Business trade name or DBA and physical location: (This name and address is
Other entity name:
Check if foreign address (See instructions)
for the business location.)
Check if foreign address (See instructions)
A
A
Name:
B
B
If sole owner (last name, first name, middle initial, Suffix)
Street Address:
P.O. Box numbers cannot be used as a business location address.
C
C
Primary Address:
D
City:
D
E
City:
F
State:
E
Zip Code:
G
State:
F
Zip Code:
County:
Township:
G
H
County:
H
Business Location
(
)
I
Telephone Number:
J
E-Mail Address:
EXT
I
B
D
E
8.
A
C
Sole Proprietor
Partnership
LLP
LP
Corporation
Check the type of organization of this business:
G
H
J
F
I
K
S Corp
LLC
Nonprofit
Fed Govt
Other Govt
Other
9. Indiana Secretary of State Control #
See
for requirements.
10. All corporations answer the following questions: Otherwise, proceed to Question 11.
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
Month
Day
Year
11.
North American Industry Classification System
(NAICS): Please enter a primary and any
A
B
D
C
PRIMARY
secondary code(s) that may apply.
12. Owner, Partners, or Officers (Attach separate sheet if necessary.)
Social Security Numbers are required in accordance with IC 4-1-8-1.
A
B
G
I
J
C
E
F
H
D
Social Security Number Last Name, First Name, Middle Initial, Suffix
Title
Street Address
City
State
Zip Code
1
2
3
Tax(es) to be Registered for this Business Location (Check all that apply.)
Sales Tax (Complete Section B for a Registered Retail Merchants Certificate.)
13.
E
Withholding Tax (Complete Section C.)
Out-of-State Use Tax (Complete Section B.)
A
F
County Innkeepers Tax (Complete Section E.)
Private Employment Agency (See instructions on page 2.)
B
G
Food and Beverage Tax (Complete Section D.)
C
Tire Fee (Complete Section G.)
H
D
Motor Vehicle Rental Excise Tax (Complete Section F.)
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