Form Reg-1 - Business Taxes Registration Application Page 6
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617.Business Use Tax
Business use tax is due when a business purchases taxable goods or services,
including the purchase or lease of assets, consumable goods, and promotional
items, for use in Connecticut without paying Connecticut sales tax. (If you are
registered for or are registering for sales and use taxes, you do not need to complete
this section.)
Will you be purchasing taxable goods or services for use in Connecticut without
paying Connecticut sales tax? ......................................................................................................
Yes
No
__ __ - __ __ - __ __
If you answered Yes to the business use tax question, enter the tax liability start date: .........
m
m
d
d
y
y
If you answered No, you must complete the Business Use Tax Declaration section below.
Business Use Tax Declaration: By registering for any of the taxes listed in this application, you have indicated to DRS
that you may have a business use tax liability. Therefore, based on your application, you will be automatically registered
for the business use tax unless you complete the following declaration.
I, ____________________________________________ (name of taxpayer or name of authorized representative
of taxpayer), acknowledge that I have read and understand the information concerning the business use tax and
declare that I will not be liable for business use tax. Please initial here. ________________
18.Registration Fee Schedule
Amount Due
a. If registering for Sales and Use Taxes or Room Occupancy Tax, enter $50.00 ....................
a.
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
b. If registering for Cigarette Dealer’s License, enter $25.00 ................. b.
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
c. Penalty for operating without a cigarette dealers
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
license ($5.00 per day): ____________ days X $5.00 = ................... c.
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
d. Total Cigarette Dealer’s License Fee (add Line b and Line c) ...............................................
d.
e. Total Registration Fee Due (add Line a and Line d) ...............................................................
e.
You must include the total registration fee due with Form REG-1 or your registration application will not be processed and will be returned.
19. All Applicants Must Sign the Following Declaration
I declare under penalty of law that I have examined this application and, to the best of my knowledge and belief, it is true,
complete, and correct. I understand that the penalty for willfully delivering a false application to DRS is a fine of not more
than $5,000, or imprisonment for not more than five years, or both.
Signature of Owner, Partner, LLC Member, or Corporate Officer
Date
Telephone Number
Sign Here
(
)
Keep a copy
for your
Print Name of Owner, Partner, LLC Member, or Corporate Officer
Title
records.
Mail to: Department of Revenue Services
Make the check or money order payable to:
PO Box 2937
Commissioner of Revenue Services
Hartford CT 06104-2937
Page 8 of 8
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