Form Sfn 21869 - Sales And Use Tax Permit Application - 2000 Page 2
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216. Complete If You Acquired The Business In Whole Or In Part
For Office Use Only
a. Date Of Acquisition ____________________________________
Month
Day
Year
b. Prior Owner’s Business Name and Address
______________________________________________________________________________________________________
❐ Yes
❐ No
c. Prior Owner’s Sales/Use Tax Number _______________________
Is Prior Owner Still in Business?
❐ Yes
Permit No._________ ❐ No
17. Do you currently have or have you had a sales and use tax permit in North Dakota?
❐ Yes
❐ No
18. Is Business Seasonal?
If Yes, Give Period of Operation _______________________________________
❐ Yes
❐ No
19. Is Business Part Time?
Daytime Telephone Number__________________________
❐ $500 or more per month
❐ $150.00 - $250.00 per month
20. Estimated Sales/Use Tax Liability
❐ $250.00 - $500.00 per month
❐ less than $150.00 per month
21.
The application Must Be Signed by:
* Sole Proprietorship - Owner
* Association or Partnership - Each member (Additional sheets may be attached.)
* Corporation - President, Vice President, Secretary or Treasurer (whomever is charged with the responsibility for filing returns and for
paying tax liabilities)
* Limited Liability Company - Governor or manager if run by Board of Governors; Individual designated to oversee the day-to-day
operations of LLC, if run by members. Written evidence of this authority should be attached to application.
LIABILITY OF CORPORATE OFFICERS FOR SALES AND USE TAX North Dakota Century Code §§ 57-39.2-18 and 57-40.2-15.1, make the
corporate officer or officers having control, or supervision of, or charged with the responsibility for filing the required sales and use tax returns
and payments personally liable for failure to do so. When this responsibility changes, this office must be notified. Dissolution of a Corporation
or a LLC does not discharge the officer’s, manager’s or governor’s liability to file a return or remit the tax due.
Effective August 1, 1999, state law provides Corporations and LLCs the option of posting a bond or cash deposit instead of having its Corporate
officers or LLC managers or governors held personally liable for taxes due. Please contact our office if your Corporation or LLC wishes to
exercise this option.
(Don't forget to sign the application before submitting it to the ND Office of State Tax Commissioner)
_____________________________________________________________________________________________________________________________
Printed Name
Signature
Title
*Social Security Number
_____________________________________________________________________________________________________________________________
Printed Name
Signature
Title
*Social Security Number
_____________________________________________________________________________________________________________________________
Printed Name
Signature
Title
*Social Security Number
I declare under the penalties of North Dakota Century Code § 12.1-11-02, which provides for a Class A misdemeanor for making a false statement in a governmental
matter, that this application, including any accompanying schedules and statements, has been examined by me and to the best of my knowledge and belief is a
true, correct, and complete application.
Instructions
This application must be completed in its entirety. Failure to complete each question will delay processing of your application and may
result in your application being returned. Questions that do not apply to your activities should be completed with N/A for Not Applicable.
No fee is required with your application, however, our review of your application may result in a request for a cash or surety bond. A
request for a bond (which helps ensure full payment of any sales or use tax liability you may accrue) is based on a number of variables,
including your past filing and payment history and the type of business you intend to open.
Once issued, permits are continuous and need not be renewed. Permits are valid until canceled (at your request) or revoked (by the Tax
Commissioner) for failure to file sales and use tax returns, failure to pay accrued sales and use tax, or failure to supply a cash or surety
bond upon request.
Federal Identification Number (Question 6): The Internal Revenue Service (IRS) requires all corporations and all businesses withholding
federal income taxes from employees' wages to have a FEIN. You may obtain an application for this number by writing to your local IRS
office or calling them toll free at 1-800-829-1040. If you haven't been assigned a number, write "applied for" and send your completed sales
tax permit application to our office. You must send your FEIN to us after it is assigned.
Description Of Business Activity (Question 11): If you will be engaged in more than one general business activity, a description of each
activity is needed. Example: Western Apparel (75%) and Farm and Ranch Equipment (25%).
*In compliance with the Federal Privacy Act of 1974, Public Law 93-579, disclosure of an individual's social security number on this form
is mandatory and is required under North Dakota Century Code § 57-39.2-14(1). This section of state law also requires disclosure of a
firm’s FEIN if the IRS requires the firm to obtain a FEIN number (Questions 6, 9 and 21).
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