Form Cra - Combined Registration Application - 2012

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2012

FORM

Comptroller of Maryland

CRA

Combined Registration Application

Page I

12CRA0049

SECTION A: All applicants must complete this section.

1 a. 9 digit Federal Employer Identification Number (See instructions)

b. Social Security number of owner, officer or agent responsible for taxes

(Required by law)

2. Legal name of dealer, employer, corporation or owner

3. Trade name

(if different from Legal name of dealer, employer, corporation or owner)

4. Street Address of physical business location (P.O. box not acceptable)

City

County

State

ZIP code

(9 digits if known)

Telephone number

Fax number

E-mail address

5. Mailing address (P.O. box acceptable)

City

State

ZIP code

(9 digits if known)

6. Reason for applying:

New business

Additional location(s)

Merger

Purchased going business

Re-activate/Re-open

(check all that apply)

Change of entity

Remit use tax on purchases

Reorganization

Other (describe) _________________________

7. Previous owner’s name: First Name or Corporation Name

Last Name

Title

Telephone number

Street address (P.O. box acceptable)

City

State

ZIP code

(9 digits if known)

Type of registration:

Maryland Number if registered:

Type of ownership:

(must check appropriate box(es))

(Check one box)

Sales and use tax

_________________________

Sole proprietorship

Non-Maryland corporation

Sales and use tax exemption

Partnership

Governmental

for nonprofit organizations

_________________________

Nonprofit organization

Fiduciary

Tire recycling fee

_________________________

Maryland corporation

Business trust

Admissions & amusement tax

_________________________

Limited liability company

Employer withholding tax

_________________________

10. Date first sales made

Unemployment insurance

_________________________

in Maryland: (mm dd yyyy)

___ ___

___ ___ ___ ___

Alcohol tax

_________________________

11. Date first wages paid

in Maryland subject

to withholding: (mm dd yyyy)

Tobacco tax

_________________________

___ ___

___ ___ ___ ___

12. If you currently file a

Motor fuel tax

_________________________

consolidated sales and

use tax return, enter the

Transient vendor license

_________________________

8 digit CR number of

your account:

____ ____ ____ ____ ____ ____ ____ ___

13. If you have employees enter the number of your workers’ compensation insurance policy or binder:

14. (a) Have you paid or do you anticipate paying wages to individuals, including corporate officers, for services performed in Maryland?

Yes

(b) If yes, enter date wages first paid (mm dd yyyy)

____ ____

____ ____ ____ ____

15. Number of employees:

16. Estimated gross wages paid in first quarter of operation:

17. Do you need a sales and use tax account only to remit taxes on untaxed purchases?

Yes

18. Describe for profit or nonprofit business activity that generates revenue. Specify the product manufactured and/or sold, or the type of service performed.

COM/RAD - 093

12-49