Form Dr 0589 - Sales Tax Special Event Application - 2010

DR 0589 (07/23/10) Web

Departmental Use Only

Colorado department of revenue

P.O. BOx 13200

vendor id

DenveR, COLORADO 80201

(303) 238-SeRv(7378)

sales tax

speCial event appliCation

REGISTRATION/ACCOUNT NUMBER

1. Do you have a sales tax account in Colorado?

Yes

no

3. indicate type of organization

Individual

A

General Partnership

Limited Partnership

IF YeS, Registration Account # _____________________________________________

Limited Liability Company (LLC)

2. event Location (City in which your event is being held)

Limited Liability Partnership (LLP)

Limited Liability Limited Partnership (LLLP)

Corporation/'S' Corp.

Association

______________________________________________________________________

estate/Trust

County in which your event is being held

ZIP

Government

Joint venture

Non-profit

1. Taxpayer Name (owner, partners or other business organization) (last, first, middle)

2. Trade name/Doing Business As (if applicable)

B

3a. City in which your business is located

State

ZIP

3b. County in which your business is located

Telephone

(

)

4. Mailing Address (residence address, include unit #)

City

State

ZIP

County

Telephone

Social Security # (Fed. emp. # if applicable)

(

)

5. List specifics products you provide (Explain in Detail).

C

(1) Owner/Partner Name (last, first, middle) If Corporation, give Corporation name

Social Security # (Fed. emp. # if applicable)

1a.

Address (residence or P.O. Box, street, city, state, ZIP)

Telephone

(

)

1b.

(2) Owner/Partner Name (last, first, middle) If Corporation, give Corporation name

Social Security # (Fed. emp. # if applicable)

2a.

Address (residence or P.O. Box, street, city, state, ZIP)

Telephone

(

)

2b.

D

if there are other partners, list on separate sheet using the same format.

PeRIOD OF evenT

e

FeeS

Indicate which applies to you

from

to

Single event

Single event

Multiple Event

License

$

0120-750

(999)

Multiple Event

i declare under penalty of perjury in the second

License

$

F

degree that the statements made in this application

0140-750

(999)

are true and complete to the best of my knowledge.

total

Make check payable to the:

(signature required below)

amount due $

.00

Colorado Department of Revenue

Signature of Owner, Partner or Corporate Officer

Title

Date

The State may convert your check to a one time electronic banking transaction. Your bank account may be debited as early as the same day received by the State. If converted, your check will

not be returned. If your check is rejected due to insufficient or uncollected funds, the Department of Revenue may collect the payment amount directly from your bank account electronically.