Form Bt-1 - Business Tax Application (Page 9 of 12) in pdf

(Please print legibly or type the information on this application.)

Page 3a

Business Tax Application

Section E: County Innkeepers Tax Registration (see instructions on page 2)

(No Registration Fee)

Contact the Department at (317) 233-4015 for more information regarding this tax.

1. Date room rentals or accommodations begin from this location:

Month

Year

Section F: Motor Vehicle Rental Excise Tax Registration (see instructions on page 3)

(No Registration Fee)

Contact the Department at (317) 233-4015 for more information regarding this tax.

1. Date motor vehicle rental or leasing begins:

Month

Year

2. If the address shown on Section A, Line 9 is in Indiana, make sure that a tax district number has been entered on that line.

3. If you are renting or leasing from a location outside Indiana and the vehicles carry Indiana plates, enter the tax district number(s) to receive excise tax credit:

______________________

Section G: Prepaid Sales Tax on Gasoline for Qualified Distributors (see instructions on page 3)

($100.00 Registration Fee)

Contact the Department at (317) 232-3524 for more information regarding this tax.

1. Enter your Indiana licensed gasoline distributor number:

2. Date of first gasoline sale:

3. Estimated number of gallons purchased/sold monthly:

Month

Day

Year

4. Mailing name and address for prepaid sales tax returns (if different from Section A, Line 3):

In care of:

Street Address:

City:

State:

Zip Code:

5. Name of contact person:

6. Contact Person’s Daytime Telephone Number:

(

)

EXT

All retail merchants who are issued a permit to collect Prepaid Sales Tax on Gasoline will be required to file monthly detailed reports (ST-103QD) with the Department.

A Prepaid Sales Tax Permit (BT-2) is not assignable and is valid only for the distributor in whose name it is issued.

Bonding Procedure

Concurrently with the filing of this application for a permit, a qualified distributor must file a bond with the Department. Below is the prescribed formula for calculating the correct bond amount.

Estimated average number of gallons supplied monthly from Section G, Line 3....................................................

Multiply Line 1 by .033 (Round to the nearest dollar amount)..............................................................................

Estimated bond amount (multiply the amount on Line 2 by 3)...............................................................................

The amount on Line 3 is the amount of your bond, provided it is at least two thousand dollars ($2,000) which is the minimum bond amount. Indiana Code 6-2.5-7-8 states that the Department

shall determine the amount of the distributor's bond. Please use the most accurate figures available to avoid a deficient bond. Please enclose Bond Form ST-160 or another form of surety

and return it to the Department with this application.

In order to obtain a permit to collect Prepaid Sales Tax on Gasoline, the Indiana Department of Revenue requires that each refiner, distributor or terminal operator agrees to

make payment to the Department by means of "Electronic Funds Transfer" as defined in I.C. 4-8.1-2-7. An EFT authorization must be completed and returned to the Department.

For further information regarding EFT filing, and/or EFT authorization agreement contact the Department at (317) 232-5500.

Signature Section

Contact the Department at (317) 486-5518 for more information regarding this application.

I hereby certify that the statements are correct.

Signature: ______________________________________________________ Title: ___________________________________________ Date: ____________________________

This application must be signed by the owner, general partner, corporate officer, or resident agent before it will be accepted by the Department.

(I.C. 6-8.1-3-4)

NOTE: Failure to remit sales tax due and/or income tax withheld is a felony punishable by imprisonment, a fine of $10,000 plus a 100% fraud penalty.

The partners or corporate officers are each personally, jointly and severally liable for the sales and use tax collected and the withholding tax withheld. These

taxes are trust fund taxes and are not discharged in bankruptcy proceedings.

Upon completion of appropriate sections, sign, date and mail

INDIANA DEPARTMENT OF REVENUE

the application and fee(s) if applicable to:

SYSTEM SERVICES

P O BOX 6197

INDIANAPOLIS IN 46206-6197