Form App/uc-001 - Arizona Joint Tax Application - 2000
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3APP/UC-001 (5/00)
ARIZONA JOINT TAX APPLICATION
DEPT. OF REVENUE
DEPT. OF ECONOMIC SECURITY
PO BOX 29069
PO BOX 6028
PHOENIX AZ 85038-9069
PHOENIX AZ 85005-6028
IMPORTANT: See attached instructions before completing this application. You must complete each section below or your application will be returned. For licensing questions on
Transaction Privilege, Withholding or Use call (602) 542-4576 or 1-800-634-6494. For questions on Unemployment Insurance call (602) 248-9396. Please return completed
application to: Department of Revenue, PO Box 29069, Phoenix AZ 85038-9069.
I. LICENSE TYPE
Transaction Privilege Tax ( TPT )
Withholding/Unemployment Tax (if hiring employees)
Use Tax
TPT For Cities ONLY
II. TYPE OF OWNERSHIP OR EMPLOYING UNIT
Individual
Association
Other (Please Explain)
Partnership
Trust
Limited Liability Company Limited
Liability Partnership
Corporation
State of Inc._______ Date of Inc.____________
Sub Chapter S
* Tax exempt organizations must attach a copy of the
Internal Revenue Service letter of determination.
III. BUSINESS INFORMATION
LEGAL BUSINESS NAME / OWNER-EMPLOYING UNIT
BUSINESS OR DBA NAME
MAILING ADDRESS (STREET, ROUTE NO. OR P.O. BOX)
IN CARE OF
CITY
STATE
ZIP CODE
BUSINESS PHONE NUMBER
(
)
PRIMARY LOCATION OF BUSINESS (Must be Physical Address) STREET, CITY, STATE, ZIP CODE
ARIZONA COUNTY
IS YOUR BUSINESS LOCATED ON AN INDIAN RESERVATION?
YES
NO
IF YES, PLEASE TELL US WHICH ONE. ________________________________________________________
For additional locations, complete supplement form on reverse of instructions.
DESCRIPTION OF BUSINESS (MUST INCLUDE TYPE OF MERCHANDISE SOLD OR TAXABLE ACTIVITY OR TYPE OF EMPLOYMENT)
DATE BUSINESS STARTED IN ARIZONA
DATE SALES BEGAN
DATE EMPLOYEES FIRST HIRED
AVERAGE NO. OF EMPLOYEES
TPT FILING METHOD:
CASH RECEIPTS
ACCRUAL
DO YOU SELL NEW MOTOR VEHICLE TIRES OR VEHICLES? IF YES, CHECK HERE
ARE YOU LIABLE FOR FEDERAL UNEMPLOYMENT TAX
FEDERAL EMPLOYER IDENTIFICATION NUMBER (FOR EMPLOYERS AND CORPORATIONS)
Yes
No
Yes (Attach copy)
No
DO YOU HAVE AN IRS WRITING THAT GRANTS AN EXCLUSION FROM FEDERAL UNEMPLOYMENT TAX?
IV. IDENTIFICATION OF OWNER (AND SPOUSE IF MARRIED) PARTNERS, CORPORATE OFFICERS, MEMBERS AND/OR MANAGING MEMBERS
OR OFFICIALS OF THIS EMPLOYING UNIT
The authority for mandatory requirement for Social Security Numbers is provided in A.A.C. R6-3-1703. If the owner, partners, corporate officers or combination of partners or corporate officers, members
and/or managing members own or control more than 50% of another business in Arizona, attach a list of the businesses, percentages owned and unemployment insurance account numbers.
NAME (Last, First, M.I.)
SOC. SEC. NO.
TITLE
% OWNED
COMPLETE RESIDENCE ADDRESS
PHONE NUMBER
(
)
(
)
(
)
(
)
Do you have or have you previously had an Arizona State Tax Number? Yes
No
If yes, fill in below and check here if you want to cancel the existing number
BUSINESS NAME
UNEMPLOYMENT NO.
WITHHOLDING NO.
TPT NO.
V. LOCATION OF TAX RECORDS (by whom and where your records are kept)
NAME OF COMPANY OR PERSON TO CONTACT
PHONE NUMBER
(
)
ADDRESS (Street, City, State and ZIP) (Do not use P.O. Box or Route No.)
THIS APPLICATION MUST BE COMPLETED, SIGNED, AND RETURNED AS PROVIDED BY ARS § 23-722.
Equal Opportunity Employer/Program
This document available in alternative formats by contacting the UI Tax Office.
ADOR 50-4002 (5/00)
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