Form Ap-171 - Texas Tax Questionnaire Page 2
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3AP-171-2
(Rev.1-07/5)
TEXAS TAX QUESTIONNAIRE
Page 1.
• PLEASE READ INSTRUCTIONS
• TYPE OR PRINT
• DO NOT WRITE IN SHADED AREAS
CHECK THE TAX TYPE FOR WHICH
CEMENT PRODUCTION
SULPHUR PRODUCTION
YOU WILL BE RESPONSIBLE
For Comptroller's use only
1.
Legal name of owner (Sole owner, partnership, corporation or other name)
•
FEEAPP
Job name:
2.
Mailing address (Street & number, P.O. Box or rural route and box number)
00991
•
Tax type / reason
City
State
ZIP Code
County
2
0
•
•
•
Reference number
Area code
Number
3. Enter the daytime phone number of the person
•
primarily responsible for filing tax returns .......................................
Master name change
01170
2
FALCON
4. Enter your Social Security Number if you are a sole owner ................
0 - Send
5. Enter your Federal Employer's Identification (FEI)
1 - Do not send
1
Number, if any ................................................................................
Master account set-up
3
01100
FALCON
Master mailing address
change
01180
FALCON
6. Are you a subsidiary or division
If, "YES," enter
YES
NO
of another company?
number ................
County code
7. Do you now have a taxpayer number for
reporting any Texas tax OR aTexas
If, "YES," enter
YES
NO
Vendor Identification Number?
number ................
Master phone number
add/change
8. Enter the date of your first cement/sulphur production (Month, day, year) ............................
01185
FALCON
Secondary mailing
9. Indicate how your business is owned.
1 - Sole owner
2 - Partnership
3 - Texas corporation
address set-up
7 - Limited partnership
6 - Foreign corporation
4 - Other (explain)
02720
FALCON
Charter number
Charter date
10. If your business is a Texas corporation, enter the charter
number and date ........................................................
Ownership type
11. If your business is a foreign corporation, enter home state, charter number, Texas Certificate of Authority number & date.
Home state
Charter number
Texas Cert. of Auth. number
Texas Cert. of Auth. date
0 0 0 0
Home state
Identification number
12. If your business is a limited partnership, enter the home
Tax type
state and identification number ..................................
0
County code
13. List all general partners or principal officers of your business. (Attach additional sheets if necessary)
If you are a sole owner, skip Item 13.
Partnership set-up
Social Security or Federal Identification (FEI) Number
Title
Name (First, middle initial, last)
01140
FALCON
•
•
XASETT
Phone (Area code & no.)
Home address (Street & number, city, state, ZIP Code)
Set up
Cement Production
Social Security or Federal Identification (FEI) Number
Title
Name (First, middle initial, last)
Sulphur production
•
•
Effective date
Phone (Area code & no.)
Home address (Street & number, city, state, ZIP Code)
mm
dd
yyyy
•
Title
Name (First, middle initial, last)
Social Security or Federal Identification (FEI) Number
•
•
Phone (Area code & no.)
Vendor hold
Home address (Street & number, city, state, ZIP Code)
0 - YES
•
1 - NO
Title
Social Security or Federal Identification (FEI) Number
Name (First, middle initial, last)
•
•
Included in audit
Phone (Area code & no.)
Home address (Street & number, city, state, ZIP Code)
0 - YES
1 - NO
•
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