Form Dr 0002 - Colorado Direct Pay Permit Application
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1
2Departmental Use Only
DR 0002 (08/28/13)
COLORADO DEPARTMENT OF REVENUE
Denver CO 80261–0013
Colorado Direct Pay Permit Application
*140002==19999*
General Information
1. Reason for Filing This Application
Original Application
Renewal
2. Indicate Type of Organization
Individual
Corporation
Trust
General Partnership
‘S’ Corporation
Non–profit 501 (c)(3) (Please enclose copy
of the IRS letter of exemption.)
Limited Partnership
Association
Limited Liability Company (LLC)
Estate
Other Non–profit
Limited Liability Partnership (LLP)
Government
Limited Liability Limited
Joint Venture
Partnership (LLLP)
Organization Information
1. Taxpayer or Partner Last Name or Corporate Name
First Name
Middle Initial
Permit Number
Period
(MM/YY) - (MM/YY)
—
—
L90
2a. Trade Name/Doing Business As (if applicable)
2b. FEIN
3a. Address of Principal Place of Business In Colorado
City
State
Zip
3b. County
If business is within limits of a city, what city?
Phone Number
(
)
4a. In Care of (c/o) Last Name
In Care of (c/o) First Name
Middle Initial
4b. Mailing Address (if different from above) ( include unit number)
City
State
Zip
5. What products and/or services do you provide?
Phone Number
(
)
6a. Owner/Partner/Corp. Officer
Title
6b. Address
City
State
Zip
SSN
FEIN
Phone Number
(
)
7a. Owner/Partner/ Corp. Officer
Title
7a. Address
City
State
Zip
SSN
FEIN
Phone Number
(
)
8. Enter the aggregate amount of Colorado purchase, which were made in the previous
12 months, subject to tax imposed by Article 26 of Title 39 C.R.S.
$
.00
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Parent category: Financial