Form Wv/bus-App - West Virginia Office Of Business Registration, West Virginia State Tax Department Taxpayer Assistance Locations
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WEST VIRGINIA OFFICE OF BUSINESS REGISTRATION
WV/BUS-APP
(Rev. 2/00)
INSTRUCTIONS FOR COMPLETION ARE FOUND ON PAGE 8 OF THIS BOOKLET
SECTION A: COMPLETE THIS SECTION TO REGISTER WITH THE WEST VIRGINIA STATE TAX DEPARTMENT
1.
WEST VIRGINIA TAXPAYER IDENTIFICATION NUMBER:
If you have a Federal Employers Identification Number, enter it. (All partnerships, corporations and sole-owners
with employees must have a FEIN). If sole-owner (no employees), enter social security number.
2.
BUSINESS NAME AND ACTUAL PHYSICAL LOCATION
3. MAILING ADDRESS (Where returns are to be sent)
Legal Business Or Corporate Name (Please print or type)
Name (Please print or type)
DBA Division, Subsidiary or Trade Name
Additional Space For Name If Needed
Owner's Name (If Sole Owner)
Address (Street) DO NOT USE A POST OFFICE BOX NUMBER
Address (Street Or P.O. Box)
City
State
Zip Code
City
State
Zip Code
4.
BUSINESS CLASS DESCRIPTION (FROM PAGES 18 THROUGH 21):
Enter primary business class:
Description of your business activity:
and secondary business class :
5.
BUSINESS DATA:
A.
Beginning date of business in West Virginia for the location entered in item 2 on this application:
B.
County where business is located. NOTE: County must match city in item 2 above.
C.
Person completing this application: Name:
Telephone #:
D.
Business telephone number:
K
K
E.
Estimated annual gross income for this location:
0 - $20,000
over $20,000
F.
Previous name of this business, if any, owner's name and location:
G.
Are you now or have you ever been registered to do business in West Virginia? ................................................................... Yes
No
If yes, give name and West Virginia Identification Number:
H.
If you have other locations registered or multiple business locations being registered, do you desire to file consolidated tax returns?
Yes
No
If yes, enter taxes to be consolidated and West Virginia Identification Number you desire to file under:
I.
Taxable year end for Federal Tax purposes - Enter month
J.
If nonprofit, do you have 501 C exemption status from the IRS? If yes, attach copy of determination letter. .......................... Yes
No
You must have a control num-
K.
Enter 5-digit Control Number assigned by the Secretary of State’s Office, if applicable
ber to submit this application.
6.
ENTER TYPE OF BUSINESS OWNERSHIP:
K
K
K
K
A Sole-Owner
D1 General Partnership
E Joint Venture
Z Other (Specify below)
K
K
K
B Domestic Corporation
D2 Limited Partnership
F Association
K
K
K
C Foreign Corporation
D3 Limited Liability Partnership
G Limited Liability Company
PARTNERS - MEMBERS - OFFICERS - OWNERS:
NAME -
HOME ADDRESS
SOCIAL SECURITY NUMBER
HOME TELEPHONE NUMBER
7.
CHECK APPROPRIATE BLOCKS:
E Sell tangible personal property to consumers at retail level and
and do not maintain
K
K
A Operate a collection agency
K
B Operate an employment agency
an established place of business in West Virginia (transient vendor)
K
K
C Make consumer loans
F Use commercial weighing or measuring devices (i.e. scales, gas pumps, etc.)
K
K
D Make supervised loans (loans pursuant to a
G Offer or sell consumer goods or services in West Virginia by Telemarketing
revolving loan account or take assignments)
8.
TYPE OF ACTIVITY:
K
K
K
K
A Service
C Wholesale
E Contracting
G Manufacturing
K
K
K
K
B Retail
D Both (Retail & Wholesale)
F Rental
Z Other (Specify - Attach Information)
FOR DEPARTMENT USE ONLY
I certify this application to be true and correct to the best of my knowledge.
SIGNATURE
TITLE
D A T E
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