Form Cd-3 - Application For Meals & Rentals Tax Operators License & Renewal - New Hampshire Department Of Revenue Administration
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1
2FORM
NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
CD-3
APPLICATION FOR MEALS & RENTALS TAX
055
OPERATORS LICENSE & RENEWAL
FOR DRA USE ONLY
LICENSE REQUIRED BEFORE OPERATING
License Number
Be sure to read instructions on reverse side before filling out this form.
$5.00 fee must accompany this application
Date Issued
New Application
Renewal License #
PLEASE TYPE OR PRINT CLEARLY
Filing Requirements
1
BUSINESS NAME
2
NAME OF ENTITY
$5.00 FEE
3
MAILING ADDRESS
MAILING ADDRESS CONTINUED
4
5
CITY OR TOWN
ZIP CODE
STATE
Corporation
6a
Type of Legal Organization:
Proprietorship
2
3
Partnership
Fiduciary
5
Non-Profit
1
4
6b
LLC Taxed as:
2
Complete either 6(a) or 6(b) but not both.
Proprietorship
Corporation
3
Partnership
1
(Do Not Enter SSN Here)
7
Federal Employer Identification Number of the above operation: FEIN
If you have not entered an FEIN on line 7 above, under what social security number or department identification number will your business taxes for this
8
operation be filed? SSN:
or DIN:
N L
9
List individual owner, partners, members or managing member (see instructions) or president and treasurer:
PRINT NAME
SOCIAL SECURITY NUMBER
RESIDENCE ADDRESS
TITLE
CITY/TOWN, STATE, ZIP CODE
RESIDENCE ADDRESS
PRINT NAME
SOCIAL SECURITY NUMBER
TITLE
CITY/TOWN, STATE, ZIP CODE
RESIDENCE ADDRESS
PRINT NAME
SOCIAL SECURITY NUMBER
TITLE
CITY/TOWN, STATE, ZIP CODE
PRINT NAME
TITLE
10
Contact Person if other than above
11
Residence # (
)
Cellular Telephone # (
)
Business Telephone # (
)
STREET, CITY, ZIP CODE
12
Physical Business Address in NH
(Required)
13
Proposed opening date
14 Type of business activity
for new application)
15
Check here if you serve....
Food
Alcoholic Beverages
Number of Seats in Restaurant and/or Lounge
{
{
{
Sleeping Accommodations
Function Rooms
Check here if you rent.....
16
Motor Vehicles
Number of Seats in Function Room
Number of Rooms
17
Check here
if you are requesting permission to file returns on a seasonal basis (less than twelve returns per year).
If yes what months will the business operate?
18
Prior business name
Prior Owner(s)
FOR DRA USE ONLY
I hereby certify that the above given information is true and correct and in conformity with applicable state laws.
x
x
SIGNATURE (IN INK) OF PREPARER OTHER THAN TAXPAYER
DATE
SIGNATURE (IN INK) OF TAXPAYER
DATE
PRINT PREPARER'S NAME & IDENTIFICATION NUMBER
PRINT SIGNATORY NAME & TITLE
Make checks payable to State of New Hampshire
NH DRA
PREPARER ADDRESS
MAIL
COLLECTION DIVISION
TO:
PO BOX 454
CONCORD, NH 03302-0454
CITY/TOWN, STATE AND ZIP CODE
Form CD-3
Rev. 09/2007
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