Fillable Form Bwa - Idaho Beer And Wine Tax Permit Application printable pdf download

Form Bwa - Idaho Beer And Wine Tax Permit Application

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BWA

IDAHO BEER AND WINE TAX PERMIT APPLICATION

EFO00111

8-01-07

For State Use Only

IDAHO STATE TAX COMMISSION

800 PARK BOULEVARD, PLAZA IV

PO BOX 36

BOISE, ID 83722

334-7660 in the Boise area or

(800) 972-7660 toll free

Instructions are on page 2.

1. Type of business

___Sole proprietor

___Partnership

___Corporation

___S corporation

___Limited liability company

2. Business activity

(Check all that apply)

___Winery

___Brewery

___Wine distributor

___Beer wholesaler

___Wine direct shipper

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

7. Doing business as (DBA) name

6. Social Security number

8. Mailing address

State

Street address or PO Box

City

Zip Code

City

9. Business locations

State

Street address

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Mailing address

City

State

Zip Code

10. Mailing address

for report forms

11. Contact person

12. Telephone number

13. E-mail address

14. Date you began or will begin selling/shipping beer or wine in/into Idaho 15. Idaho Alcohol Beverage Control license number

16. Tax year end

17. Idaho ABC winery license number (If you're an out-of-state direct shipper, attach a certified copy of your state's alcohol beverage license.)

18. Have you previously held an Idaho beer or wine tax permit?

Yes

If yes, what year?

Permit number

Business name

19. List (a) owner, spouse, (b) all partners, or (c) all corporate officers. Attach additional page if necessary.

Name

Address

Social Security number or EIN

YOU MUST ATTACH PROOF OF YOUR BEER AND/OR WINE BOND TO THIS APPLICATION. (See instructions.)

CERTIFICATION: I agree to comply with reporting, payment, recordkeeping, 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