Form Jt-1/uc-001 - Arizona Joint Tax Application

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JT-1/UC-001 (10/10)
ARIZONA JOINT TAX APPLICATION
Incomplete applications WILL NOT BE PROCESSED. All required
IMPORTANT:
To complete this online,
information is designated with asterisk
*
To complete this application see attached instructions. Please return Complete
go to
application with appropriate license fee(s) to: License & Registration Section,
Department of Revenue, PO BOX 29032, Phoenix AZ 85038-9032.
Section A: Taxpayer Information (Print legibly or type the information on this application.)
2. Type of Ownership
*
1. License Type (Check all that apply)
*
Individual / Sole Proprietorship
Sub-Chapter S Corporation
Transaction Privilege Tax (TPT)
Partnership
Association
Withholding/Unemployment Tax (if hiring employees)
Professional Limited Liability
Trust
Use Tax
Limited Liability Company
Government
TPT For Cities ONLY
Limited Liability Partnership
Estate
Corporation
Joint Venture
3. Federal Employer Identifi cation Number (Required for Employers and
State of Inc.
Receivership
Entities other than Sole Proprietors) or Social Security Number
*
Date of Inc.
Tax exempt organizations must attach a copy of the Internal Revenue Service letter of determination.
4. Legal Business Name / Owner / Employing Unit
*
7. Fax Number
5. Business or “Doing Business As” Name
6. Business Phone Number
*
*
(
)
(
)
9. Country
8. Mailing Address (Street, City, State, ZIP code)
*
10. Email Address
11. Is your business located on an Indian Reservation?
Yes
If yes,
(See Section G for listing of Reservations)
No
13. County
12. Physical Location of Business (Street, City, State, ZIP code) Do not use PO Box or Route No.
*
For additional business locations, complete Section B-12
14. Are you a construction contractor?
15. Did you acquire, or change the legal form of business of, all or part of an existing business?
*
*
Yes
(See Bonding Requirements below)
Yes
If yes, you must complete the Unemployment Tax Information (Section D)
No
No
Bonding Requirements: Prior to the issuance of a Transaction Privilege Tax license, new or out-of-state contractors are required to post a Taxpayer Bond
for Contractors, unless the Contractor qualifi es for an exemption from the bonding requirement. The primary type of contracting being performed determines
the amount of bond to be posted. Bonds may also be required from applicants who are delinquent in paying Arizona taxes or have a history of delinquencies.
For more information on bonding, please see the “Taxpayer Bonds” publication, which is available online or at the Department of Revenue offi ces.
16. Description of Business (Must include type of merchandise sold or taxable activity; for employers, the type of employment)
*
17. NAICS Code: (Select at least one. Go to for a listing of codes)
*
18. Identifi cation of Owner, Partners, Corporate Offi cers, Members / Managing Members or Offi cials of this employing unit
A. Name (Last, First, MI)
B. Soc. Sec. No.
C. Title
D. % Owned
E. Complete Residence Address
F. Phone Number
*
*
*
*
*
*
(
)
0%
(
)
0%
0%
(
)
0%
(
)
If the owner, partners, corporate offi cers or combination of partners or corporate offi cers, members and/or managing members own more than 50% of or
control another business in Arizona, attach a list of the businesses, percentages owned and unemployment insurance account numbers.
THIS BOX FOR AGENCY USE ONLY
New
Acct. No.
LIAB
DLN
Change
Start
LIAB Est.
TPT
Revise
S/E Date
WH
Reopen
ADOR 10194 (10/10)
Previous ADOR 74-4002

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