Form Ap-159 - Coastal Protection Fee Page 2
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3AP-159-2
TEXAS QUESTIONNAIRE
(Rev.1-07/6)
COASTAL PROTECTION FEE
• PLEASE READ INSTRUCTIONS
• TYPE OR PRINT
• DO NOT WRITE IN SHADED AREAS
1. Legal name of owner
FEEAPP
JOB NAME -
00991
T Code
6620
Tax type/Reason code
Ref. no.
2. Mailing address
Business phone (Area code & no.)
MASTER ON FILE
T Code
01100
City
State
ZIP Code
County
Code
T Code
01180
T Code
01185
3. Federal Employer's Identification Number
4. Social Security Number if sole owner
5. Check if
neither
1
2
3
If "YES," enter
YES
NO
6. Are you a subsidiary or division of another company?
number
7. Do you now have a Taxpayer Number for reporting any Texas tax
If "YES," enter
YES
NO
OR a Texas Vendor Identification Number?
number
8. Enter your beginning effective date (month, day, year)
9. Type of ownership
1 - Sole owner
2 - Partnership
4 - Other (Explain)
Charter Number
Charter Date
3 - Texas corporation
State
Charter Number
Texas Cert. of Auth. No .
Date
6 - Foreign corporation
State
Identification Number
0 0 0 0
Type
7 - Limited partnership
10. Identification of owners: sole owner, all general partners or principal corporation officers.
01140
T Code
(Attach additional sheets if necessary.)
Name (First name, middle initial, last name)
Social Security Number
Title
Home street address
City
State
ZIP Code
Name (First name, middle initial, last name)
Social Security Number
Title
Home street address
City
State
ZIP Code
Name (First name, middle initial, last name)
Social Security Number
Title
Home street address
City
State
ZIP Code
SUCCESSOR LIABILITY - I f you purchased an existing business or business assets , complete I tems 11-14. I f you did not , skip to I tem 15.
11. Enter the former owner's trade name. If known, enter the former owner's Texas taxpayer number.
Trade name
Taxpayer number of former owner
12. Enter the former owner's legal name. If known, enter the former owner's address and telephone number.
Phone (Area code & no.)
Legal name of former owner
Address of former owner (Street & number, city, state, ZIP code)
13. Check each of the following items you purchased.
Inventory
Corporate stock
Equipment
Real estate
Other assets
14. Enter the purchase price of the business or assets purchased and the date of purchase.
Purchase price
Date of purchase
$
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Parent category: Financial