Form 20 - Nebraska Tax Application

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Nebraska Tax Application
FORM
20
ne
dep
• Please Print, Sign, and Attach Check
of
PLEASE DO NOT WRITE IN THIS SPACE
nebraska
department
of revenue
RESET FORM
1 Do you hold, or have you previously held a
2 Federal Employer Identification Number
2
3 County of Business Location
3
4 4 For Department Use Only
Nebraska Identification Number?
YES
YES
YES
NO
NO
NO
If Yes, give number:
NAME AND LOCATION ADDRESS
NAME AND LOCATION ADDRESS
(Print Clearly)
(Print Clearly)
NAME AND MAILING ADDRESS
NAME AND MAILING ADDRESS
Name Doing Business As (dba)
Name Doing Business As (dba)
Name
Name
Legal Name
Street Address (Do Not Use P.O. Box)
Street or Other Mailing Address
City
State
Zip Code
City
State
Zip Code
5 Name and Address of Legal Entity/Owner
Is your Nebraska location within the city limits?
(1)
YES
YES
YES
YES
(2)
(2)
(2)
(2)
NO
NO
NO
NO
6 Identify Owner and Spouse (if joint ownership), Partners, Members, or Corporation Officers (One of the listed Individuals must sign as Applicant)
Social Security Number
Social Security Number
Social Security Number
Social Security Number
Social Security Number
Name, Address, City, State, Zip Code
Name, Address, City, State, Zip Code
Name, Address, City, State, Zip Code
Name, Address, City, State, Zip Code
Name, Address, City, State, Zip Code
Title, If Corporate Officer
Title, If Corporate Officer
Title, If Corporate Officer
Title, If Corporate Officer
Title, If Corporate Officer
7 Type of Ownership
(1)
(1)
(1)
(1)
Sole Proprietorship
Sole Proprietorship
Sole Proprietorship
Sole Proprietorship
(5)
(5)
(5)
(5)
Foreign Corporation
Foreign Corporation
Foreign Corporation
Foreign Corporation
(9)
(9)
(9)
(9)
Nonprofit Organization
Nonprofit Organization
Nonprofit Organization
Nonprofit Organization
(2)
(2)
(2)
(2)
Partnership
Partnership
Partnership
Partnership
(6)
(6)
(6)
(6)
Domesticated Corporation
Domesticated Corporation
Domesticated Corporation
Domesticated Corporation
(10)
(10)
(10)
(10)
Cooperative
Cooperative
Cooperative
Cooperative
(3)
(3)
(3)
(3)
Nonprofit Corporation
Nonprofit Corporation
Nonprofit Corporation
Nonprofit Corporation
(7)
(7)
(7)
(7)
Governmental
Governmental
Governmental
Governmental
(11)
(11)
(11)
(11)
Limited Liability Company
Limited Liability Company
Limited Liability Company
Limited Liability Company
(4)
(4)
(4)
Domestic Corporation
Domestic Corporation
Domestic Corporation
(8)
(8)
(8)
Fiduciary (Estate or Trust)
Fiduciary (Estate or Trust)
Fiduciary (Estate or Trust)
8 Accounting Basis
9 Accounting Period (Type of Year)
9
(1)
(1)
Cash
Cash
(1)
(1)
Calendar–January 1 to December 31
Calendar–January 1 to December 31
(2)
(2)
Accrual
Accrual
(2)
(2)
(2)
Fiscal–12 Month Ending
Fiscal–12 Month Ending
Fiscal–12 Month Ending
(3)
(3)
Other
Other
(3)
(3)
(3)
Fiscal–52 or 53 Week Ending
Fiscal–52 or 53 Week Ending
Fiscal–52 or 53 Week Ending
10 Location of Records
(1)
(1)
(1)
Same as Location Address
Same as Location Address
Same as Location Address
(2)
(2)
(2)
Same as Mailing Address
Same as Mailing Address
Same as Mailing Address
(3)
(3)
Other Address
Other Address
Address
Address
City
City
State
State
Zip Code
Zip Code
11 Reason for Filing Application, Check Appropriate Box(es). If Box 3 is checked, you must cancel your old Nebraska I.D. Number.
(1)
(1)
(1)
Original Application
Original Application
Original Application
(3)
(3)
(3)
Change Business Entity (Indicate Nebraska I.D. Number
Change Business Entity (Indicate Nebraska I.D. Number
Change Business Entity (Indicate Nebraska I.D. Number
(4)
(4)
Renewal-Cigarette Dealers Only
Renewal-Cigarette Dealers Only
(2)
(2)
(2)
Change in Partners
Change in Partners
Change in Partners
of Previous Entity): _____________________________)
of Previous Entity): _____________________________)
of Previous Entity): _____________________________)
(5)
(5)
(5)
Add Tax Program
Add Tax Program
Add Tax Program
From:
From:
To:
To:
(6)
(6)
Other (Attach Explanation)
Other (Attach Explanation)
Proprietorship
Proprietorship
Proprietorship
Proprietorship
Proprietorship
Proprietorship
Partnership
Partnership
Partnership
Partnership
Partnership
Partnership
Limited Liability Company
Limited Liability Company
Limited Liability Company
Limited Liability Company
Limited Liability Company
Limited Liability Company
Corporation
Corporation
Corporation
Corporation
Corporation
Corporation
12 Provide a description of your business operations and products or services sold:
a. Business type:
a. Business type:
a. Business type:
a. Business type:
a. Business type:
a. Business type:
a. Business type:
a. Business type:
Retailer
Retailer
Retailer
Retailer
Retailer
Retailer
Retailer
Retailer
Lessor
Lessor
Lessor
Lessor
Lessor
Lessor
Lessor
Lessor
Wholesaler
Wholesaler
Wholesaler
Wholesaler
Wholesaler
Wholesaler
Wholesaler
Wholesaler
Manufacturer
Manufacturer
Manufacturer
Manufacturer
Manufacturer
Manufacturer
Manufacturer
Manufacturer
Contractor
Contractor
Contractor
Contractor
Contractor
Contractor
Contractor
Contractor
Farmer
Farmer
Farmer
Farmer
Farmer
Farmer
Farmer
Farmer
Other
Other
Other
Other
Other
Other
Other
Other
b. If your business does not operate year round, identify the months you operate
c. How many business establishments do you operate? in Nebraska
c. How many business establishments do you operate? in Nebraska
in U.S.A.
in U.S.A.
d. If you purchased an existing business, identify the previous owner
Name
Address
City
Zip Code
Nebraska I.D. Number
COMPLETE REVERSE SIDE
2-2007
7-100-1975 Rev.
Supersedes 7-100-1975 Rev. 2-2006

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