Form Cd-3 - Application For Meals & Rentals Tax Operators License & Renewal - New Hampshire Department Of Revenue Page 2

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NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
FORM
CD-3
APPLICATION FOR MEALS & RENTALS TAX OPERATORS
LICENSE & RENEWAL (RSA 78-A:4)
Page 2
Operators having more than one license may request permission to fi le on a consolidated basis provided all licenses
20
use the same Federal Employer Identifi cation Number. Operators must designate one license number to be the master
CONSOLIDATED
(primary) license number and provide the business name, address and Meals & Rentals license number of each member
RETURN
of the group.
20(a) ARE YOU REQUESTING TO BE A MEMBER OF A CONSOLIDATED MEALS & RENTALS FILING GROUP?
YES
NO
IF YES, SPECIFY MASTER (PRIMARY) LICENSE NUMBER ___________________
20(b) ARE YOU REQUESTING TO BE A MASTER (PRIMARY) FILER FOR A CONSOLIDATED MEALS & RENTALS FILING
GROUP?
YES
NO
IF YES, ATTACH A LIST INDICATING MEMBERS’ MEALS & RENTALS LICENSE #, BUSINESS NAME & ADDRESS.
21
IS THIS BUSINESS A FRANCHISE?
YES
NO
IF YES, COMPLETE THE FOLLOWING:
FRANCHISE
INFORMATION
FRANCHISE NAME
CONTACT PERSON (LAST, FIRST, MI, SUFFIX)
BUSINESS ADDRESS
CITY
STATE
ZIP CODE + 4
MAILING ADDRESS
CITY
STATE
ZIP CODE + 4
TELEPHONE / EXTENSION
FAX
E-MAIL ADDRESS
22
THE “PHYSICAL BUSINESS ADDRESS IN NH” AS LISTED ON LINE 12 IS: (CHECK ONE):
OWNED
LEASED/RENTED
BUSINESS
LOCATION
INFORMATION
LANDLORD NAME
LANDLORD TELEPHONE NUMBER
23
23(a) IF CORPORATION, ENTER NAME AND ADDRESS OF NH REGISTERED AGENT:
REGISTRATION,
LICENSING
& PERMIT
INFORMATION
23(b) DOES OR DID THE APPLICANT PREVIOUSLY HOLD OR HAVE AN INTEREST IN ANY LIQUOR LICENSE?
YES
NO
IF YES, DATE ISSUED
LICENSE NUMBER
NAME OF LICENSEE
23(c) HAS APPLICANT PREVIOUSLY OWNED/HAD INTEREST IN ANY MEALS & RENTALS LICENSE?
YES
NO
IF YES, DATE ISSUED
LICENSE NUMBER
NAME OF LICENSEE
23(d) DO YOU HOLD ANY OTHER LOCAL AND/OR STATE LICENSES OR PERMITS?
YES
NO
IF YES, LIST (ATTACH ADDITIONAL SHEETS IF NECESSARY):
TYPE OF LICENSE
DATE ISSUED
LICENSE NUMBER
NAME OF LICENSEE
Form CD-3
Rev. 5/2010
2

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