Sales And Contractors' Excise Tax License Application Form - 1999
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1
2Department of Revenue
Sales and Contractors’ Excise Tax
License Application
Revised September 1999
FOR OFFICE USE ONLY
Please provide all of the following information that applies to
your situation. All applicable information MUST be
completed before a license will be issued.
__ __ - __ __ __ - __ __ __ __ __ __ __ __ __ __ - __ __ - __ __ __
1. Federal Employer’s Identification Number (FEIN)(if applicable):
2. Owner, Partner, or Corporation Name (name of persons/entity owning business):
Street Address:
E-Mail Address (if applies):
Daytime
(
)
City:
State:
Zip Code:
County:
Phone:
3. Mailing Address (if different from 2): Street or PO Box Number:
Daytime
(
)
State:
City:
Zip Code:
Phone:
4. Business Name (if different from 2):
Business Street Address:
Daytime
(
)
City:
State:
Zip Code:
County:
Phone:
5. Mailing Address (if different from 4): Street or PO Box Number:
(
)
City:
State:
Zip Code:
FAX Number:
6. Tax information and returns mailed to: Street or PO Box Number:
City:
State:
Zip Code:
Daytime Phone :
Attn:
7. Type of Ownership:
Single Owner
Trust
Partnership/Limited Partnership
Corporation/Date of Incorporation:
If corporation, date of registration with SD Secretary of State:
Limited Liability Company (Please include articles of organization and operating agreement.)
Other:
8. Type of License Requested (check all that apply):
Sales
Use
Wholesaler
Manufacturer
Contractors’ Excise
9. Brief Description of Business (grocery store, accountant, etc.):
10. This business is:
Full-time
Part-time
Transient (no permanent South Dakota business location)
12.
Accounting Method:
Cash
Accrual
11. Start Date:
$
13. Estimated Monthly Taxable Gross in South Dakota resulting from this business:
14. Do you have any current or cancelled tax licenses issued by the SD Department of Revenue?
Yes
No
If “Yes”, please list below (includes sales, use, contractors’ excise, motor fuel, liquor, cigarette, IFTA, IRP, etc.) and proceed to back page. If “No”,
proceed directly to back page.
Type:
License Number:
Operated from:
to
Type:
License Number:
Operated from:
to
ST
UT
MT
WT
County:
ET
County:
SIC
Est. Tax:
SIC
Est. Tax:
FCD:
C
A
License Status:
FCD:
C
A License Status:
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Parent category: Financial