Form 8144 Jpso Application - Bureau Of Revenue And Taxation

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NEWELL NORMAND
Jefferson Parish Sheriff’s Office
Bureau of Revenue and Taxation
Sheriff and Ex-Officio Tax Collector
P.O. Box 248
Gretna, LA 70054
Parish of Jefferson
Voice: (504) 376-2459
Fax: (504) 376-2469
1. Date of application ________/________/________
A. ❏ Sales/Use Tax
B. ❏ Occupational License Tax
2. Application For:
C. ❏ Chain Store Tax
D. ❏ General Registration
❏
❏
3. Reason for applying:
A.
Started new business
C.
Other (specify): ______________________________________________
❏
B.
Purchased ongoing business:
Name of previous owner: _______________________________________________
❏
❏
Have you ever registered with this office?
Yes
No
If yes, list below the business name.
Business name: ___________________________________________________
If closed, enter date closed: ______/______/______
❏
❏
❏
4. Federal Employer ID Number
None
5. LA Sales Tax Number
None
6. Local Tax Number
None
7. A. Taxpayer Name/Corporate Name: _______________________________________________________________________________________________
B. Trade name of business: ________________________________________________________________ Telephone: ( _____ ) ______________________
8. A. Business address (NO P.O. Box or General Delivery): ________________________________________________________________________________
City: _____________________________________________________________ State: ____________ Zip Code: __________________–___________
B. Address for receiving tax forms/correspondence: ____________________________________________________________________________________
City: _____________________________________________________________ State: ____________ Zip Code: __________________–___________
D. Location of accounting records: Check one as noted in ❏ 8A ❏ 8B
C. Website: __________________________________________
If other, list complete address below.
........................
___________________________________________________________________________________________________________________________
❏
❏
❏
❏
❏
❏
9. Type of organization:
Sole Proprietor
Partnership
Corporation
LLC
LLP
LP
❏
❏
❏
Governmental
Nonprofit (IRS Ruling must be attached)
Other _____________________________________
10. If sole owner/individual: Name: ______________________________________________________________ SSN: _________________________________
(Attach copy of valid photo I.D.)
Home address: ____________________________________________________________________ Telephone: ( _____ ) _______________________
City: _____________________________________________________________ State: ____________ Zip Code: __________________–___________
11.
If corporation, LLC, LLP,
Name
Title
SSN: _____________________________
LP or partnership: name,
title, Social Security
Address
Telephone: ( ____ ) __________________
Number, home address
and telephone number of
Name
Title
SSN: _____________________________
officers, members, man-
agers or partners
Address
Telephone: ( ____ ) __________________
Attach additional sheets
if necessary to complete
Name
Title
SSN: _____________________________
this information.
Address
Telephone: ( ____ ) __________________
12.Contact Person: __________________________________________________________________________ Title: _________________________________
Telephone: ( _____ ) __________________________
Email address: ________________________________________________________________
13. Agent for service of process: Name: _________________________________________________________ Telephone: ( _____ ) ______________________
Physical Address: __________________________________________________________________________________________________________
City: _____________________________________________________________ State: ____________ Zip Code: __________________–___________
14. Date business started/acquired at
15. Number of other business locations
16. Number of retail business locations
this location: _______/_______/_______
in Jefferson Parish? ______________
nationwide? (incl. this location) ____________
17. A. Description of business activity: _________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________
❏
❏
B. NAICS Code (see listing attached): _____________________________________ C. Food/Beverage Sales:
Yes
No
I affirm that the
information
Signature of applicant: _______________________________________________________ Title: ___________________________________
given on this
application is
Signature of preparer: _______________________________________________________ Date: ___________________________________
true and correct.
PLEASE REFER TO INSTRUCTIONS – INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED

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