Form Wv/sn-1 - West Virginia Application For Sparklers And Novelties Registration Certificate
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1
2WEST VIRGINIA APPLICATION FOR
WV/SN-1
REV 3-09
SPARKLERS AND NOVELTIES REGISTRATION CERTIFICATE
MAIL APPLICATION TO: WEST VIRGINIA STATE TAX DEPARTMENT, INTERNAL AUDITING DIVISION, PO BOX 2666, CHARLESTON WV 25330-2666
1. WEST VIRGINIA TAXPAYER IDENTIFICATION NUMBER:
If you have a Federal Employers Identification Number, enter it. (All partnerships and
sole-owners with employees must have a FEIN). If sole-owner, enter social security number.
2. BUSINESS NAME AND ACTUAL PHYSICAL LOCATION*
3. MAILING ADDRESS (Where certificates are to be sent)
Legal Business or Corporate Name
Name
DBA Division or Subsidiary Name
Additional space for Name (if needed)
Owner’s Name (if Sole Owner)
Address (Street)
Address (Street or PO Box)
DO NOT USE A POST OFFICE BOX NUMBER
City
State
Zip Code
City
State
Zip Code
* REVERSE SIDE OF APPLICATION MUST BE COMPLETED, IF FILING AN APPLICATION FOR A BUSINESS THAT HAS
MORE
THAN ONE PHYSICAL LOCATION IN WEST VIRGINIA FROM WHICH SPARKLERS AND NOVELTIES WILL BE
SOLD.
4. DO YOU HAVE A CURRENT WEST VIRGINIA BUSINESS REGISTRATION CERTIFICATE FOR THE PHYSICAL LOCATION
IN THIS STATE FROM WHICH YOU INTEND TO SELL SPARKLERS AND NOVELTIES?
YES
NO
A. IF YES, ENTER YOUR ACCOUNT IDENTIFICATION NUMBER AND BUSINESS NAME AS IT APPEARS ON YOUR
BUSINESS REGISTRATION CERTIFICATE. IF MORE THAN ONE PHYSICAL LOCATION, SEE REVERSE SIDE.
IF A LOCATION DOES NOT HAVE A CURRENT BUSINESS REGISTRATION CERTIFICATE, APPLICANT WILL NEED
TO FILE AN “APPLICATION FOR REGISTRATION CERTIFICATE”, (FORM WV/BUS-APP).
5. THIS APPLICATION FOR A SPARKLERS AND NOVELTIES REGISTRATION CERTIFICATE IS FOR THE REGISTRATION
PERIOD (CHECK ONE)
REGISTRATION PERIOD
REGISTRATION FEE
W.
JULY 1, 2008 THROUGH JUNE 30, 2010
$30.00 PER LOCATION
X.
JULY 1, 2009 THROUGH JUNE 30, 2010
$15.00 PER LOCATION
6. FEE COMPUTATION:
$
.
X $30.00 =
NUMBER OF BUSINESS LOCATIONS REGISTERED
.
$
X $15.00 =
NUMBER OF BUSINESS LOCATIONS REGISTERED
$
.
TOTAL SPARKLER & NOVELTIES REGISTRATION FEES DUE
A SPARKLER AND NOVELTIES REGISTRATION CERTIFICATE ONLY AUTHORIZES THE HOLDER TO SELL SPARKLERS
AND NOVELTIES AS DEFINED IN WV CODE
§ 29-3-23 (AS AMENDED BY S.B. 482, 1995). THIS CERTIFICATE DOES NOT
.
AUTHORIZE THE VENDOR TO SELL ANY FIREWORKS THAT MAY NOT BE LAWFULLY SOLD IN WEST VIRGINIA
MAKE REMITTANCE PAYABLE TO THE WEST VIRGINIA STATE TAX DEPARTMENT
PLEASE RETAIN A COPY OF THIS REGISTRATION APPLICATION FOR YOUR RECORDS
*B46030901W*
SIGNATURE
DATE
TITLE
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