Application For Direct Payment Permit For Use Tax On Tangible Personal Property Form - Arizona Department Of Revenue, Arizona

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Arizona Department of Revenue
Application for Direct Payment Permit
for Use Tax on Tangible Personal Property
1)
Federal Employer ID No. :
- - - -
2)
Arizona TPT License No. :
- - - -
3)
Legal Business Name:
4)
Trade Name (DBA Name):
5)
Business Location in AZ:
Street
(Not PO Box Number)
City
Zip
6)
Mailing Address:
City, State, ZIP Code:
7)
Type of Business:
8)
Dollar amount of annual purchases in the preceding calendar year:
9)
Principal reason for requesting a direct payment permit:
A)
The place of business where the property will be used is not known at the time of purchase.
Provide an example:
B)
The manner in which the property will be used is not known at the time of purchase.
Provide an example:
This application must be signed by one of the following: an owner, partner, corporate offi cer or association member.
Signature:
Date:
Name (Print):
Title:
Phone:
Mail to:
Arizona Department of Revenue
License & Registration Section
1600 W Monroe
Phoenix AZ 85007-2650
ADOR 60-5405 (11/02)

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