Form Sfn 59507 - Application For Income Tax Withholding And Sales & Use Tax Permit - 2013 Page 2

Download a blank fillable Form Sfn 59507 - Application For Income Tax Withholding And Sales & Use Tax Permit - 2013 in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form Sfn 59507 - Application For Income Tax Withholding And Sales & Use Tax Permit - 2013 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

Application For Income Tax Withholding

And Sales & Use Tax Permit

Page 2

Prepaid Wireless Telecommunication 911 Fee

13. Do you sell prepaid wireless airtime cards, prepaid wireless minutes or plans?

Yes

If yes, provide beginning date you started selling these telecommunications services

Sales & Use Tax

14. Beginning date of operations for North Dakota sales/use tax

Month

Day

Year

Yes

15. Do you currently have or have you had a sales and use tax permit in North Dakota?

Permit No.

Yes

16. Is business seasonal or part time?

If seasonal, give period of operation

If business is temporary, give approximate time period of business activity in North Dakota

through

Yes

18. Will you be selling farm equipment?

Yes

17. Will you be selling alcohol?

If sales returns should be mailed to a different address, indicate below.

20. Business Telephone Number

19. Name of Sales Tax Return Preparer

State

ZIP Code

21. Address of Preparer (Street or PO Box, City)

Telephone Number

22. Name of individual to contact for sales tax matters

Withholding Tax

23. Beginning date of North Dakota Income Tax Withholding

Month

Day

Year

24. Estimated number of employees in North Dakota and estimated wages to be paid in current calendar year.

Amount of wages

Number of employees

If withholding returns should be mailed to a different address, indicate below.

26. Business Telephone Number

25. Name of Withholding Tax Return Preparer

State

ZIP Code

27. Address of Preparer (Street or PO Box, City)

Telephone Number

28. Name of individual to contact for withholding tax matters

Application must be signed by authorized individual

Date:

Signature:

(Authorized Individual)

Print name:

Title:

Phone No:

I declare under the penalties of North Dakota Century Code ch. 12.1-11-02, which provides for a Class A misdemeanor for making a false statement in a

governmental matter, that this application, including any accompanying schedules and statements, has been examined by me and to the best of my

knowledge and belief is a true, correct and complete application.

PRIVACY ACT NOTIFICATION

In compliance with the Privacy Act of 1974, disclosure of a social security number or Federal Employer Identification Number (FEIN) on this form is required

under N.D.C.C. §§ 57-01-15, 57-38-56, and 57-39.2-19, and will be used for tax reporting, identification, and administration of North Dakota tax laws.

Disclosure is mandatory. Failure to provide the social security number or FEIN may delay or prevent the processing of this form.

Send completed form to:

Office of State Tax Commissioner

Business Registration

Fax: 701.328.0332

600 E. Boulevard Ave., Dept. 127

E-mail: taxregistration@nd.gov

Bismarck, ND 58505-0599

Phone: 701.328.1241