Form Ap-145 - Coin-Operated Machine Inventory Supplement For General Business License Holders

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AP-145
(Rev.6-04/4)
COIN-OPERATED MACHINE INVENTORY SUPPLEMENT
FOR GENERAL BUSINESS LICENSE HOLDERS
For Comptroller Use Only
NOTE: This supplement is to be used to record your machine inventory. YOU MUST PROVIDE THIS INFORMATION
(Occupations Code 2153.202).This form must be returned with your application for coin-operated machine tax
00990
4420
license and tax permits.
• TYPE OR PRINT
• DO NOT WRITE IN SHADED AREAS
1. Legal name of owner
2. Taxpayer number
(Sole owner, partnership, corporation, or other name)
3. For each machine OWNED, list the serial number/inventory I.D. number, machine make, and machine type. Also, indicate whether each
machine is exhibited or displayed on location. A COMPUTER PRINTOUT OF ALL NUMBERED INVENTORY MAY BE USED. If you use a
computer printout, you MUST complete Item 4.
MACHINE SERIAL NUMBER/
EXHIBITED OR DISPLAYED
MACHINE TYPE CODE
MACHINE MAKE OR MANUFACTURE
INVENTORY I.D. NUMBER
(Use letter codes from Item 4.)
ON LOCATION
1
YES
NO
2
YES
NO
3
YES
NO
4
YES
NO
5
YES
NO
6
YES
NO
7
YES
NO
8
YES
NO
9
YES
NO
10
YES
NO
11
YES
NO
12
YES
NO
13
YES
NO
14
YES
NO
15
YES
NO
16
YES
NO
17
YES
NO
18
YES
NO
19
YES
NO
20
YES
NO
21
YES
NO
22
YES
NO
23
YES
NO
YES
NO
24
25
YES
NO
4. Enter the number of EACH TYPE of music, skill, or pleasure coin-operated machine that you have in ALL locations.
– A –
– B –
– C –
– D –
– E –
– F –
PHONOGRAPHS
POOL TABLES
PINBALL GAMES
VIDEO GAMES
DARTS
OTHER
5. TOTAL NUMBER of machines in ALL locations that require tax permits. (Total of Item 4 A - F) ..................................
___________________
You have certain rights under Ch. 559, Government Code, to review, request, and correct information we have on file about you.
Contact us at the address or toll-free number listed on your application.

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