Form Wv/brt801a - Reissuance Of Business Registration Certificate (Permanent) - 2010

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STATE OF WEST VIRGINIA
State Tax Department, Revenue Division
P.O. Box 2666
Charleston, WV 25330-2666
Name
Address
Account
City
State
Zip
Location Info:
Name
Address
City
State
Zip
WV/BRT801A v.83-Web
REISSUANCE OF BUSINESS REGISTRATION CERTIFICATE (PERMANENT)
Effective July 1, 2010, the Business Registration Certificate will be permanent. Additional information can be found on the reverse
side of this return or by visiting
Date Due:
FEIN:
07-01-2010
1. If exempt from the registration fee, check ONE of the appropriate boxes:
Foreign Retailer voluntarily collecting &
remitting Use Tax on sales to W.Va. customers
Government Agency
Agriculture or Farming
Non-Profit Organization
2. If out of business, indicate last date business was conducted in W. Va.
MM
DD
YYYY
3. Do you sell cigarettes or other tobacco products?
Yes
No
4. Primary NAICS Code
$
0
0
$30.00
.
5. Registration Fee Due:
Amount Remitted
If Yes, indicate new name and location address in the space
Business Name and/or Location Address Change:
Yes
No
provided on the back of this return.
Mailing Address Change:
If Yes, indicate new mailing address in the space provided.
Yes
No
Street 1
City
State
Zip
(Signature of Taxpayer)
(Phone Number)
(Date)
MAKE CHECK PAYABLE AND MAIL TO: WEST VIRGINIA STATE TAX DEPARTMENT
PO BOX 2666, CHARLESTON, WV 25330-2666
FOR ASSISTANCE CALL
(304) 558-3333
TOLL FREE WITHIN WV
(800) 982-8297
B
5
1
0
4
1
0
0
1
W
For more information visit our web site at:
File online at: https://mytaxes.wvtax.gov

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