Form A-101 - Application For Permit/certificate

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APPLICATION FOR PERMIT/CERTIFICATE
WISCONSIN DEPT. OF REVENUE
• See instructions on attached sheet for completing this form.
PO Box 8902
• Type or print clearly.
Madison WI 53708-8902
• Send to address at right.
(608) 266-2776
• Allow 15 business days for processing and mailing of your permit/certificate
TTY (608) 267-1049
Check permit(s)/certificate(s) for which you are applying and enclose one $20 Business Tax Registration fee
(if applicable), regardless of the number of permits/certificates you have checked.
Seller’s Permit . . . . . . . . . . . . . . . . . . . . . . . . . Fee Required
Use Tax Certificate . . Fee Required
Mobile Seller’s Permit . . . . . . . . . . . . . . . . . . . Fee Required
Consumer’s Use Tax Certificate
*
Wisconsin Employer Identification Number . . Fee Required
Local Exposition Tax
*
See Line 17 below for possible exception
Department Use Only
1. True Name (Corporate, Limited Liability Company, Partnership or Individual)
Federal Emp. I.D. No.
Telephone No.
(
)
2. Trade or Business Name (if different than True Name)
Business Telephone
(
)
3. Business Address
Business located in
County
City
Village
Town
City or Post Office
State
Zip Code
of:
4. Mailing Address (if different than Business Address)
City or Post Office
State
Zip Code
5. Organization (Check one)
1
Sole Proprietor
5b
If Governmental Unit, check appropriate box
2
Partnership
Federal
County
3
Wisconsin Corporation – Enter date incorporated:
Wisconsin State Agency
Local
4
Out-of-State Corporation – Have you registered with the Wisconsin
6
Limited Liability Company – Enter date registered with the Department
Department of Financial Institutions?
Yes
No
of Financial Institutions:
5a
Other – Describe:
For federal income tax purposes, will the LLC be taxed as a:
Partnership
Corporation
Single member LLC disregarded
as a separate entity
6. Principal kinds of taxable merchandise or services you intend to sell
7. Principal business
Service
Wholesale
Other
Retail
Manufacturing
8. Have you as a Sole Proprietor, Partner(s), Limited Liability Company Member(s) or Corporate Officer(s) ever held, or now hold a permit or certificate issued by the
Wisconsin Department of Revenue?
Yes
No
(If yes, indicate type of permit or certificate, permit or certificate number, and location for which it was issued.)
Wisconsin Employer Identification
Seller’s Permit, Use Tax or Consumer’s Use Tax Certificate
9. Do you have a beer or liquor license?
Yes
No
Number Applicants Only
Applicants Only
If yes, enter
applicable Code(s)
11. Estimated amount of Wisconsin state
12. a. Estimated monthly sales
$
income tax to be withheld each
month
b. Estimated monthly sales
subject to sales or use tax
$
10. Former owner and permit number(s), if known
$
c. Estimated monthly purchases
First Wisconsin withholding will
subject to use tax
$
occur
Name
If zero entered on both lines b and c, no permit will be issued
Wisconsin taxable sales will
month
day
year
first be made
Seller’s Permit
Wisconsin Employer ID
month
day
year
13. Check all boxes that indicate the type of sales you
14. If your income year is other than the
15. Will business be operated all year?
Yes
No
will be making in the Local Exposition District.
year ending December 31, please
If No, enter
indicate your fiscal year ending date.
Month Open
Food and beverages
Automobile rentals
Month Closed
Room rentals
Fiscal Year Ending Date
16. Are you interested in receiving information about making your sales or withholding payments by electronic funds transfer (EFT)?
Yes
No
Are you interested in receiving information about the Department’s Sales Internet Process (SIP) filing program?
Yes
No
17. Check the box if your are (see instructions):
An out-of-state employer with no other tax connection to Wisconsin,
An agricultural employer with farm labor only, or
A household employer with domestic employes only.
If you have checked one of the above boxes and you are only applying for a Wisconsin employer identification number, the BTR fee is not due with this application.
All Applicants Must Complete and Sign on Reverse Side
A-101 (R. 2-01)

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