Form As/rp1 - Registration Application Sales And Use Tax Income Tax Withholding - 2003

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4
Registration Application
AS/RP1
PRINT
CLEAR
Web-Fill
Sales and Use Tax
11-03
Income Tax Withholding
North Carolina Department of Revenue
I. Identifying Information
If other, please identify type of ownership here:
1. Type of Ownership:
If a corporation, state of incorporation:
If N.C. Corporation or LLC, enter N.C. Secretary of State ID No.
2. Legal Business or Owner’s Name:
3. Trade Name(DBA Name):
4. Daytime Business Phone:
5. Fax Phone:
6. Business Location in N.C.
Street
(Not P.O. Box Number)
State
City
Zip Code
County
7. Is the business located within city or town limits?
8.
Number of locations in N.C.
Enclose list if more than one.
9. Mailing Address:
Street or P.O. Box
State
City
Zip Code
10. Federal Employer ID No.
11. Proprietor’s Social Security No.
12. List primary partners or corporate officers (President, Vice President, Secretary, and Treasurer):
Title
Address
Social Security No.
Name
II. Withholding Tax Section
- Complete this section if you are applying for an Income Tax Withholding Number.
Do you have employees who are subject to N.C. withholding?
Date on which wages were or will first be paid in N.C.
Do you make pension payments to N.C. residents?
If yes, do you choose to report the pension payment withholding separately?
Do you pay compensation (other than wages to employees) to a nonresident entity or a nonresident individual for personal services
performed in N.C.?
If yes, do you choose to report this withholding separately? (See instructions.)
Amount of tax you expect to withhold each month:
Less than $250 (Quarterly)
$250 - $2,000 (Monthly)
More than $2,000 (Semiweekly)
If your business is seasonal, fill in circles
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
for months employees are paid:
III. Sales and Use Tax Section -
Complete this section if you are applying for a Sales and Use Tax Number.
When will you start selling or purchasing items subject to N.C. sales or use tax?
(You are required to file returns beginning with the month or quarter you indicate.)
What accounting method will you use?
Will your sales be?
Retail (to users or consumers)
Both Retail and Wholesale
Wholesale (to registered merchants for resale)
What will you sell? (Be specific)
Will you sell new tires?
Will you sell electricity, telecommunications, or satellite services?
Will you lease motor vehicles to others?
Will you sell new appliances?
Are you registering only to remit use tax on your purchases?
Amount of sales tax expected each month:
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
If your business is seasonal, fill in circles for months of sales:
IV. Signature:
Title:
Date:
I
certify that, to the best of my knowledge, this application is accurate and complete.
Mail to: N.C. Department of Revenue, P. O. Box 25000, Raleigh, NC 27640-0100

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