Form Bwa - Idaho Beer And Wine Tax Permit Application - 1994
ADVERTISEMENT
1B W A
T C 0 0 1 5 1
IDAHO BEER AND WINE TAX PERMIT APPLICATION
1 2 - 1 6 - 9 4
For State Use Only
IDAHO STATE TAX COMMISSION
800 PARK BOULEVARD, PLAZA IV
P.O. BOX 36
BOISE, IDAHO 83722
( 2 0 8 ) 3 3 4 - 7 6 6 0
(800)972-7660 (ID, WA, OR & UT)
Instructions are on page 2.
1. Type of business
___Sole Proprietor
___Partnership
___S Corporation
___Limited Liability Company
___Corporation
2.
Business activity
___Winery
___Brewery
___Beer Distributor
___Wine Importer
___Beer Importer
___Wine Distributor
3.
Purpose of application
___New business
___New location
___Change in "doing business as" name
___Change in partners or shareholders ___%
4. Federal EIN
5. Legal business name
6.
Social Security Number
7. Doing business as (DBA) name
State
8.
Mailing address
Street address or P.O. Box
C i t y
Zip Code
9.
Business Locations
C i t y
State
Street address
Mailing address
State
C i t y
Zip Code
10. Mailing Address
for Report Forms
11.
Contact person
13. Tax year end
12.
Telephone number
15.
Idaho Alcohol Beverage Control license number
14. Date you began or will begin selling/shipping beer or wine in/into Idaho
16. Have you previously held an Idaho beer or wine permit?
Yes
No
If yes, what year?
Business name
Permit number
18. List (a) owner, spouse, (b) partners or (c) corporate officers.
N a m e
Address
Social Security Number or EIN
PROOF OF YOUR BEER AND/OR WINE BOND MUST BE ATTACHED TO THIS APPLICATION. (See instructions.)
CERTIFICATION: I agree to comply with reporting, payment, record keeping, and license display requirements. I certify that I am authorized as an
owner, partner, corporate officer or representative to sign this document and that the statements made are correct to the best of my knowledge.
Date
Signature
Title
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial