Form St-1 - Application For Sales And Use Tax Permit

14. List exactly the products sold or type of service rendered.

15. Date you will begin business in Arkansas?

Day

Year

16. Check type of business:

Retail

Wholesale

CHECK TYPE OF BUSINESS ENTITY:

17. Corporation

S Corporation

Individual

Partnership

LLC

LLP

Government

18. Date Arkansas Incorporated?

Day

Year

19. Please check one:

Inside city limits

Outside city limits

20. Does this business sell or serve alcohol?

If YES, please furnish the ABC number under which you are operating.

21. Does this business sell tobacco products?

22. Do you operate more than one business in Arkansas?

If YES, please list all locations, names, addresses and permit

numbers on a separate schedule.

23. Did you purchase the assets of any business?

If YES, give the name and permit number of the business.

Former business name

Former business permit number

Did you purchase the capital stock of a business?_________________

Dollar value of inventory and fixtures:__________________________

24. If you operate an out-of-state business; do you perform any type of repair or service within the state of Arkansas?

If YES, please list exactly the repair or service performed.

Important Information

A) A $50.00 FEE IS REQUIRED OF ALL ARKANSAS VENDORS ON A RETAIL OR WHOLESALE BASIS.

Out of state vendors that lease property into Arkansas or perform taxable services in Arkansas are required to pay

the $50 registration fee. Please make check payable to Department of Finance and Administration.

B) The former owner of a business must surrender the permit, and report and pay all taxes due by the business through the transfer date. A lien will attach

to the stock and fixtures to secure the State of Arkansas for delinquent taxes and is enforceable against purchaser.

C) Arkansas Code Annotated 26-18-502 states that the tax liability of the former owner transfers to the new owner when the business is sold. No permit

will be issued to the new owner until all tax liability is paid.

I DECLARE UNDER PENALTY OF PERJURY, THAT THIS APPLICATION (INCLUDING ANY ACCOMPANYING

SCHEDULES) HAS BEEN EXAMINED BY ME, AND TO THE BEST OF MY KNOWLEDGE AND BELIEF IS A TRUE,

CORRECT AND COMPLETE APPLICATION.

Original Signature of Owner/Partner/Officer

Printed Name of Owner/Partner/Officer

Date

FOR OFFICE USE ONLY - DO NOT WRITE IN THIS SPACE

SALES

USE

TEX

SIC: