Form Ut 1000 - Application For Certificate Of Registration

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UT 1000
S
O
TATE OF
HIO
(Rev 3/97)
D
T
EPARTMENT OF
AXATION
FOR STATE USE ONLY
P.O. B
530, C
, OH 43266-0030
OX
OLUMBUS
Account Number Assigned
A
C
R
PPLICATION FOR
ERTIFICATE OF
EGISTRATION
Effective Date Filing Method
Every seller of tangible personal property engaged in business in Ohio is required by Section
5741.17 of the Revisde Code to register with the State. No registration fee is required.
1.
Legal Name _________________________________________________________________________________
if partnership, list names
2.
Trade Name (if other than above) ________________________________________________________________
3.
Principal or Home Office:
Phone: ___________________
___________________________________________________________________________________________
street
city
state
zip code
4.
Mailing address for tax return or tax matters (if different than above)
Phone: ___________________
___________________________________________________________________________________________
street
city
state
zip code
5.
Federal Employer Identification Number or if none
Employer Identification No.
Social Security No.
assigned for reporting Federal Taxes, please enter
your Social Security Number.
6.
If business operates as a corporation, show officers' names and addresses below.
President ___________________________________________________________________________________
name
street
city/state
Vice-Pres ___________________________________________________________________________________
name
street
city/state
Secy/Treas __________________________________________________________________________________
name
street
city/state
7.
With reference to this application, state the date that you began, or will begin to collect the Ohio Use Tax.
___________________________________________________________________________________________
8.
State the average monthly use tax liability in the State of Ohio, if known.
$ ________________________
9.
State Type of Business Activity and Products Sold __________________________________________________
10.
Location of all distribution or sales offices or other places of business in Ohio
___________________________________________________________________________________________
name
street
city
___________________________________________________________________________________________
name
street
city
11.
Name and address of each agent operating in Ohio
___________________________________________________________________________________________
name
street
city
___________________________________________________________________________________________
name
street
city
(If additional space is required, use a supplemental sheet.)
12.
If this application is for a new Seller's account due to change in ownership, please furnish the old account number
___________________________________________________________________________________________
I hereby declare the above to be true and correct to the best of my knowledge and belief.
Date ________________________ , 19 ______
_________________________________________________
signature of seller or officer of company
MAIL TO: Ohio Department of Taxation, Use Tax Registration, P.O. Box 530, Columbus, OH 43266-0030

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