Form Bt-1 - Business Tax Application - 2014 Page 4
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Business Tax Application
(Please print legibly or type the information on this application.)
Section H: Signature Section
Contact the Department at (317) 232-4015 for more information regarding this application.
I hereby certify that the statements are correct.
Signature: ________________________________________________ Title: __________________________ Date: ______________________
This application must be signed by the owner, general partner, corporate officer, or resident agent before it will be accepted by the Depart-
ment. (IC 6-8.1-3-4)
NOTE:
Failure to remit sales tax due and/or income tax withheld is a felony punishable by imprisonment, a fine of $10,000 plus a 100-percent fraud
penalty.
The partners or corporate officers are each personally, jointly and severally liable for the sales and use tax* collected and the withhold-
ing tax withheld. These taxes are trust fund taxes and are not discharged in bankruptcy proceedings.
*This includes:County Innkeepers Tax (CIT), Food and Beverage Tax (FAB), Tire Fee (TIF), and Motor Vehicle Rental and County
Supplemental Excise Tax (MVR).
For additional information
Private Employment Agencies Only
Mail To:
Mail To:
about private employment
Indiana Department of Revenue
agencies:
Indiana Department of Revenue
Tax Administration Processing
Call (317) 232-5977
Licensing Section
P. O. Box 6197
.
100 N. Senate Room N281
Indianapolis, IN 46206-6197
Indianapolis, IN 46204
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