AP-201-5
(Rev.7-05/9)
TEXAS APPLICATION FOR SALES TAX PERMIT,
USE TAX PERMIT AND/OR
• TYPE OR PRINT
TELECOMMUNICATIONS INFRASTRUCTURE FUND ASSESSMENT SET-UP
Page 3
• Do NOT write in shaded areas.
40. Legal name of entity (Same as Item 1 OR Item 5)
41. Do you receive compensation for providing telecommunications services? .................
YES
NO
If “YES,” you are responsible for the Telecommunications Infrastructure Fund (TIF) assessment and should complete Items 42-44.
If “NO,” skip to Item 45.
month
day
year
42. Date of the first business operation that is subject to the Telecommunications Infrastructure Fund
assessment in Texas or the date you plan to start such business operation. ..............................................................................
43. Telecommunications provider type ............................
Telecommuncations Utility (24)
Commercial Mobile Service Provider (25)
44. 9-1-1 emergency communications fees you collect under Health & Safety Code, Chapter 771. (Check all that apply.)
9-1-1 (Wireless) Emergency Service Fee (91)
9-1-1 Emergency Service Fee (92)
9-1-1 Equalization Surcharge (93)
If you purchased an existing business or business assets, complete Items 45-48.
Previous owner’s taxpayer
45. Previous owner's trade name
number
(if available)
46. Previous owner’s legal name, address and phone number, if available.
Name
Phone (Area code and number)
Address (Street and number)
City
State
ZIP code
47. Check each of the following items you purchased.
Inventory
Corporate stock
Equipment
Real estate
Other assets
48. Purchase price of this business or assets and the date of purchase.
month
day
year
$
Purchase price
Date of purchase
49. The sole owner, all general partners, corporation or organization president, vice-president, secretary or treasurer,
Date of signature(s)
month
day
year
managing director, or an authorized representative must sign. A representative must submit a written power of
attorney. Applicants must be 18 or older. Parents/Legal Guardians may apply for a permit on behalf of a minor.
(Attach additional sheets if necessary.)
I (We) declare that the information in this document and any attachments is true and correct to the best of my (our) knowledge and belief.
Type or print name and title of sole owner, partner, or officer
Drivers license number/state
Date of Birth
Sole owner, partner, or officer
Type or print name and title of sole owner, partner, or officer
Drivers license number/state
Date of Birth
Sole owner, partner, or officer
Type or print name and title of sole owner, partner, or officer
Drivers license number/state
Date of Birth
Sole owner, partner, or officer
YOUR PERMIT MUST BE PROMINENTLY DISPLAYED IN YOUR PLACE OF BUSINESS. THE INFORMATION ON YOUR PERMIT
IS PUBLIC INFORMATION.
OPEN RECORDS NOTICE - Your name, address, and telephone number are public information under the Texas Public Information
Act, Chapter 552, Government Code.
Field office or section number
Employee Name
USERID
Date
1
2
3
