Form Sfn 21869 - Sales And Use Tax Permit Application - 2000

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FOR OFFICE USE ONLY
Sales And Use Tax Permit Application
Permit
North Dakota Office of State Tax Commissioner
SFN 21869 (3-00)
______________________________________________________________
______________________________________________________________
Click for Internet Link to Sales and Use Tax Requirements Guideline
______________________________________________________________
1. Business Name
2. Business Phone
(Please Print)
3. Corporate, Legal, or Owner’s Name
4. Mail Address
(Street or Post Office Box )
City
State
Zip Code
5. North Dakota Location
(Street or Post Office Box)
City
County
State
Zip Code
6. Federal Employer I.D. Number (FEIN)
7. Organization
❏ Individual
❏ Corporation
❏ Limited Liability Co.
❏ Limited Partnership
❏ Other __________________
❏ Husband/Wife
General Partnership
8. Physical Location of Records
(Street)
City
State
9. Name(s) of Owner, Partners, Corporate Officers
Name
Address
Title
Home Phone
Soc. Sec. No.
% Owned
❏ Retailer
❏ Manufacturer
10. Type of Business
❏ Wholesaler
❏ Contractor (Identify License #____________)
11. Business Activity: List the principal products or activities of your firm. Following each item, list the percentage of sales value or receipts
received from the product or activity; i.e., retail mens clothing or construction-homes.
____________________________________________
_______%
____________________________________________
_______%
12. Date Operations Will Begin/Began in ND____________________________________
13. Application Purpose
New
Change in
Additional
Month
Day
Year
Business
Ownership
Location
Attention: All Corporations, Limited Liability Companies (LLC), Limited Partnerships (LP) and Limited Liability Partnerships (LLP) must answer
questions 14 and 15. Individual Ownerships and General Partnerships are not required to answer questions 14 and 15; proceed to page 2.
North Dakota Century Code requires all foreign Corporations, LLCs, LPs and LLPs to obtain a Certificate of Authority from the North Dakota
Secretary of State before a sales and use tax permit may be issued. Questions should be directed to Secretary of State’s Office at 701-328-4284.
14. Name of state under which the Corporation, LLC, LP , or LLP is organized? ___________________________________________
15. Enter the ID number assigned to your organization by the North Dakota Secretary of State when you received your Certificate of Authority
____________________________________. Proceed to page 2.
Visit North Dakota’s New Business Registration site at , click on New Business for general information and registration forms.
For Office Use Only
o w
Tax
Dir
# of
Starting Date
Extension
SIC Code
City Tax
sp
ID
Pay
Co
City Code
Bus.
Yr
Mo
Day
Qt # days
Mail to:
Office of State Tax Commissioner
Sales Tax Compliance Section
Amount of Bond
Bond
Date
Month Day
Year
State Capitol, 600 East Boulevard Ave.
Type
Bond
(C, S, or L)
Posted
Bismarck, North Dakota 58505-0599
Phone: (701)328-3474
Website:

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