Form St 1-S - Application For Service Vendor'S License - 2000
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1Prescribed Sales TaxForm
S
O
TATE OF
HIO
ST 1-S (Rev. 9/00)
D
T
EPARTMENT OF
AXATION
FOR STATE USE ONLY
P.O. B
182215, C
, OH 43218-2215
OX
OLUMBUS
License Number Assigned
A
S
V
'
L
PPLICATION FOR
ERVICE
ENDOR
S
ICENSE
Effective Date Filing Method
Section 5739.17 of the Ohio Revised Code provides for a service vendor's license when the person performs
certain selected services subject to the Ohio sales tax.
I/we herewith make application to the Tax Commissioner of the State of Ohio for a service vendor's license. (For sole owner, print individual's
name; for partnership, print full names of all partners; for corporation, print corporation's name and Ohio corporation charter number. If a foreign
corporation, certificate number issued by Secretary of State authorizing transaction of business in Ohio. Section 1703.01 O.R.C.)
____________________________________________________
#________________________________
name
corporation charte
___________________________________________________________________________________________________
trade name or dba
Address shown must be vendor's residence or permanent business location
___________________________________________________________________________________________________
street address
___________________________________________________________________________________________________
city
state
zip code
telephone no.
Mailing address (if other than above)
___________________________________________________________________________________________________
street address
___________________________________________________________________________________________________
city
state
zip code
Briefly describe the type of service which you provide _________________________________________________
_______________________________________________________________________________________________________________________
Federal Employer Identification Number or if none
Social Security No.
Federal Identification No.
assigned for reporting Federal Taxes, please enter
your Social Security Number.
Check type of ownership:
0.
Corporation
1.
Sole Owner
2.
Partnership
3.
Fiduciary
4.
Association
5.
Business Trust
If vendor is a corporation, partnership or partner, show officers' names and addresses below.
President / Partner ___________________________________________________________________________
name
street
city/state
Vice-Pres. / Partner ___________________________________________________________________________
name
street
city/state
Secy/Treas. / Partner ___________________________________________________________________________
name
street
city/state
When did you or will you begin providing the taxable service
____________________________________________
month
day
year
I hereby declare the above to be true and correct to the best of my knowledge and belief.
Date
signature of vendor or agent
Fee for this license -- $25.00
Monthly Tax Returns Required
Send original application and $25.00 fee made payable to Treasurer of State to
Ohio Department of Taxation, Registration Unit, P.O. Box 182215, Columbus, OH 43218-2215
Duplicate to be retained by applicant
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