Form 24 - Nebraska Registration Application For Nonresident Contractor - Department Of Revenue

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Nebraska Registration Application

FORM

for Nonresident Contractor

• Read instructions on reverse side

PLEASE DO NOT WRITE IN THIS SPACE

nebraska

department

of revenue

RESET FORM

2 Federal Employer Identiﬁcation Number

3 For Dept. Use Only

Do you hold, or have you previously held, a Nebraska Identiﬁcation Number?

YES

If Yes, give the number

NAME AND LOCATION ADDRESS

(Print Clearly)

NAME AND MAILING ADDRESS

Name

Name Doing Business As (DBA)

Legal Name

Street Address (Do Not Use P.O. Box)

Street or Other Mailing Address

City

State

Zip Code

State

Zip Code

5 Name and Address of Legal Entity/Owner

6 Identify Owner and Spouse (if joint ownership), Partners, Members, or Corporation Ofﬁcers (One of the listed individuals must sign as Applicant)

Social Security Number

Name, Address, City, State, Zip Code

Title, If Corporate Ofﬁcer

7 Type of Ownership

(1)

Sole Proprietorship

Nonproﬁt Organization

(5)

Foreign Corporation

(9)

(2)

Partnership

Domesticated Corporation

(10)

Cooperative

(6)

(3)

Nonproﬁt Corporation

Limited Liability Company

Governmental

(11)

(7)

(4)

Domestic Corporation

Fiduciary (Estate or Trust)

(8)

8 Accounting Basis

9 Accounting Period (Type of Year)

(1)

Cash

(1)

Calendar Year - January 1 to December 31

(2)

Accrual

Fiscal Year - 12 Month Ending

(3)

Other

(3)

Fiscal Year - 52 or 53 Week Ending

10 Location of Records

(1)

Same as Location Address

(3)

Other Address

(2)

Same as Mailing Address

Address

City

Zip Code

State

CONTRACTOR ELECTION FOR SALES AND USE TAX ON BUILDING MATERIALS AND FIXTURES

As required for all contractors, I hereby make my sales and use tax election. I have read the description of the three options on the back of this application

and am aware of the sales and use tax obligations associated with the election I make.

Option 1 – Retailer – Tax-Free Inventory

Option 2 – Contractor – Tax-Paid Inventory

Option 3 – Contractor – Tax-Free Inventory

• IF YOU WILL BE STARTING A PROJECT IN NEBRASKA SOON, APPLY FOR THE REQUIRED ADDITIONAL TAX PROGRAM(S) HERE.

DAY

YEAR

Check Type of Program(s) Being Applied for:

Sales and Use Tax — No Fee — Enter date of ﬁrst project in Nebraska....................................................................................

Income Tax Withholding — No Fee — Enter date of ﬁrst wages paid for project in Nebraska ...................................................

For the above tax program(s), you will be set-up to ﬁle on a quarterly ﬁling frequency.

Corporation Income Tax — No Fee — Enter beginning date .....................................................................................................

Are you an S Corporation?

YES

Partnership Income Tax — No Fee — Enter beginning date......................................................................................................

Under penalties of law, I declare that I have examined this application, and to the best of my knowledge and belief, it is correct and complete.

sign

(

)

here

Signature of Owner, Partner, Member, Corporate Ofﬁcer,

Area Code and Telephone Number

Title

Date

or Person Authorized by Attached Power of Attorney

(

)