Form Bt-1 - Business Tax Application Page 8
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12(Please print legibly or type the information on this application.)
Business Tax Application
Page 2a
Section B: Sales Tax/Out-Of-State Use Tax Registration (see instructions on page 2)
($25.00 Nonrefundable Registration Fee for Retail Merchants Certificate)
(No Fee for Out-of-State Use Tax Certificate)
Contact the Department at (317) 233-4015 for more information regarding these taxes.
1. Date of first sales at this location under this ownership:
2. Estimated monthly taxable sales:
$
Month
Year
(see instructions on page 2)
3. Is this business seasonal? Yes
No
If yes, check active months.
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Nov
Dec
Oct
Check the appropriate responses.
Check the appropriate responses.
Yes
No
Yes
No
Will you provide lodging or accommodations for periods of less than thirty
4.
11.
Will gasoline, gasohol or special fuels be sold through a metered pump?
(30) days? Complete Section E ..............................................................
12.
Will you receive gasoline, gasohol or special fuel from a refinery
5.
Will prepared foods or beverages be sold? If yes, complete Section D........
or pipeline terminal?..............................................................................
6.
Will alcoholic beverages, beer, wine or packaged liquor be sold from
13.
Will you sell and place special fuel into the fuel supply tank of a
this location?..........................................................................................
motor vehicle?..........................................................................................
If yes enter your ABC Permit Number
14.
Will you place special fuel from your storage unit into your own
motor vehicle?.........................................................................................
Expiration Date
Month
Day
15.
Will you import gasoline and/or special fuel into Indiana by tank car, tank
7.
Will new or used cars, trucks, motorcycles, or recreational vehicles be sold
truck or transport? ................................................................................
from this location? .................................................................................
Will you distribute 500,000 or more gallons of gasoline per year to other
16.
8.
Will cars or trucks (less than 11,000 lbs Gross Vehicle Weight) be rented
commercial accounts? ...........................................................................
for less than thirty (30) days from this location?........................................
If yes, complete Section F.
17.
Are you a refiner, distributor or a terminal operator which supplies gasoline
to retail outlets?.....................................................................................
9.
Do you desire a Consolidated Account Number? If yes, Form BT-1C
If yes, and you wish to become a Qualified Distributor, complete
(attached) must be completed.....................................................................
Section G.
10.
If already reporting sales tax on a consolidated basis, is this location to be
18.
Do you occasionally make sales in the State of Indiana at fairs, flea
included in your consolidated account? ....................................................
markets, etc.?............................................................................................
If yes, enter your Reporting Number.
19.
Do you have an Underground Storage Tank on your property? .................
All underground storage tanks must be registered with the Department
of Environmental Management.
20.
Mailing name and address for sales tax returns (if different from Section A, Line 3):
In care of:
Street Address:
City:
State:
Zip Code:
Section C: Withholding Tax Registration (see instructions on page 2)
(No Registration Fee)
Contact the Department at (317) 233-4016 for more information regarding this tax.
5. Date taxes first withheld from an Indiana resident/
1. Are you withholding on a nonresident shareholder, partner or beneficiary? Yes
No
employee under this ownership:
2. Is this a one time annual distribution of income? Yes
No
3. Accounting Period Year Ending Date
Month
Year
Month
Day
6. Anticipated monthly wages paid to Indiana resident/ employees:
4. Are you withholding on Professional Athletes? Yes
No
$
7. Mailing name and address for withholding tax returns (if different from Section A, Line 3):
In care of:
Street Address:
City:
State:
Zip Code:
Section D: Food and Beverage Tax Registration (see instructions on page 2)
(No Registration Fee)
Contact the Department at (317) 233-4015 for more information regarding this tax.
County
Municipality
1.
Date of first sales at this location under this ownership:
2. Will prepared foods or beverages be catered from
(City or Town)
this location into other counties?
1._______________
_______________
Yes
No
2._______________
_______________
Month
Year
3._______________
_______________
3. If yes, enter the name(s) of the county(ies)
and associated municipality.
4.________________
_______________
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