Form As 2914.1 - Application For Merchant'S Registration Certificate - 2011

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Government of Puerto Rico
Serial Number
Form AS 2914.1
DEPARTMENT OF THE TREASURY
Rev. Aug 30 11
APPLICATION FOR MERCHANT'S REGISTRATION
CERTIFICATE
PART I - INFORMATION OF MERCHANT'S PRINCIPAL OFFICE
1. Legal name of the corporation, partnership, individual owner (name, initial, last name) or other
Receipt Stamp
2. Social security or employer identification number under which the income
from this activity will be informed on the income tax return
(It is mandatory to complete this line)
3. Telephone
Ext.
4. E-mail address
5. Postal address
(Post Office Box, Urbanization or Building, Number or Apartment, Street)
Municipality / City
Zip Code
Country
State
6.
Principal office's physical address (Urbanization or Building, Number or Apartment, Street)
Country
Zip Code
State
Municipality / City
7. Type of organization:
Individual
Estate or Trust
Corporation or Partnership
8. Date of incorporation or creation: Day
9. Closing date of your accounting period:
Month
Year
Day
Month
10. Aggregate business volume, estimated or projected, at the end of the current calendar year (It shall be the sum of the business volume of all your locations):
$
,
,
.
11. Amount of locations / activities included in this application:
12. Amount of Schedules included with this application:
(It cannot be less than one)
PART II - LOCATIONS / ACTIVITIES
Indicate the information for each one of the locations operated by the business (submit Schedule AS 2914.1 if necessary).
- - You shall complete all lines of this part in order to process the application. - -
*
*
13. Trade name or "DBA"
14. Type of registration certificate requested (Check one):
Merchant
Mobile business
Temporary business
Exhibitor
Month
Year
If you checked Temporary Business or Exhibitor, indicate:(From:
Day
Year
To:
Day
Month
)
Ext.
16. Will you sell tangible personal property?
Yes
No
15. Telephone
17. Description of tangible
personal property
18. Physical address
(Urbanization or Building, Number or Apartment, Street). If it is the same as the one indicated on line 6, check here and continue on line 19
.
Municipality / City
Zip Code
Country
State
Retention: Six (6) years.

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