Form Ap-110 - Texas Application For Gross Receipts Tax Permit Page 4
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4AP-110-4
TEXAS APPLICATION
(Rev.6-09/16)
PRINT FORM
CLEAR FORM
FOR
GROSS RECEIPTS TAX PERMIT
Page 2
• Please read instructions
• TYPE or PRINT
• Do not write in shaded areas
15. Legal name of owner (Same as Item 2)
IF YOU PURCHASED AN EXISTING BUSINESS OR BUSINESS ASSETS, COMPLETE ITEMS 16-19.
For Comptroller 's use only
IF YOU DID NOT, SKIP TO ITEM 20.
OF
NR
16. Enter the former owner's trade name. If known, enter the former owner's Texas taxpayer number.
Trade name
Taxpayer number of former owner
Former owner is
Active
17. Enter the former owner's legal name. If known, enter the former owner's address and telephone number.
OOB
Legal name
Phone (Area code and number)
Address of former owner (Street & number, city, state, ZIP code)
18. Check each of the following items you purchased. (this includes the value of stock exchanged for assets.)
Inventory
Corporate stock
Equipment
Real estate
Other assets
19. Enter the purchase price of the business or assets purchased and the date of purchase.
Purchase price
Date of purchase (month, day, year)
$
The sole owner, all general partners, corporation president, vice-president, secretary, treasurer, or an
Date of application (month, day, year)
authorized representative must sign this application. Representative must submit a written power of attorney
with application. (Attach additional sheets, if necessary.)
20. I (We) declare that the information in this document and any attachments are true and correct to the best of my (our) knowledge and belief.
Type or print name and title of sole owner, partner, or officer
Sole owner, partner, or officer
Type or print name and title of sole owner, partner, or officer
Sole owner, partner, or officer
Type or print name and title of sole owner, partner, or officer
Sole owner, partner, or officer
WARNING. You may be required to obtain an additional permit or license from the State of Texas or from a local governmental entity
to conduct business. A listing of links relating to acquiring licenses, permits, and registrations from the State of Texas is available
online at You may also want to contact the municipality and county in which you will
conduct business to determine any local governmental requirements.
Field office number
E.O. name
User ID
Date
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