AP-160
(Rev.1-07/16)
TEXAS QUESTIONNAIRE
CLEAR FORM
PRINT
FOR BATTERY SALES FEE
Page 1
• Please read instructions
• TYPE or PRINT
• Do not write in shaded areas
1. Legal name of owner (Sole owner, partnership, corporation, or other name)
•
2. Mailing address (Street & number, P.O. Box or rural route and box number)
•
City
State
ZIP code
County
•
•
•
•
4. Enter a daytime phone number (Area code and number) .....................
5. Enter your social security (SSN) number if you are a sole owner ................................................
6. Enter your federal employer's identification number (FEIN), if any
1
assigned by the United States Internal Revenue Service .........................................................
FEDERAL PRIVACY ACT -
Disclosure of your social security number is required and authorized under law, for the purpose
3
of tax administration and identification of any individual affected by applicable law. 42 U.S.C. §405(c)(2)(C)(i); Tex. Govt. Code
§§403.011 and 403.078. Release of information on this form in response to a public information request will be governed by the
Public Information Act, Chapter 552, Government Code, and applicable federal law.
If "YES," enter number.
7. Are you a subsidiary or division of another company? .......................................
YES
NO
If "YES," enter number.
8. Do you now have a taxpayer number for reporting any
Texas tax OR a Texas Vendor Identification Number? ......................................
YES
NO
Month
Day
Year
9. The first sales date of batteries .............................................................................................................................
10. Indicate how your business is owned. ......
Sole owner
Partnership
Texas corporation
Foreign corporation
Limited partnership
Other (Explain) ___________________________________________________________________________
File number
File date
11. If your business is a Texas corporation,
enter the file number and date. .....................................................
12. If your business is a corporation in another state, enter the file number and date.
Home state
Charter number
Texas Certificate of Authority number
Texas Cert. of Authority date
Home state
Identification number
13. If your business is a limited partnership,
enter the home state and identification number ........................................................
14. General partners, principle officers, managing directors, or managers. (Attach additional sheets, if necessary.)
Name
SSN or FEIN
Title
•
•
Home address (Street & number, city, state, ZIP code)
Phone (Area code & number)
Name
SSN or FEIN
Title
•
•
Home address (Street & number, city, state, ZIP code)
Phone (Area code & number)
For Comptroller 's use only
IF YOU PURCHASED AN EXISTING BUSINESS OR BUSINESS ASSETS, COMPLETE ITEMS 15-18.
OF
NR
IF YOU DID NOT, SKIP TO ITEM 19.
15. Enter the former owner's trade name. If known, enter the former owner's Texas taxpayer number.
Former owner is
Trade name
Taxpayer number of former owner
Active
OOB
16. Enter the former owner's legal name. If known, enter the former owner's address and telephone number.
Legal name
Phone (Area code and number)
Address of former owner (Street & number, city, state, ZIP code)
17. Check each of the following items you purchased. (this includes the value of stock exchanged for assets.)
Inventory
Corporate stock
Equipment
Real estate
Other assets
Purchase price
Date of purchase (month, day, year)
18. Enter the purchase price of the business or
$
assets purchased and the date of purchase. .....................................