Fillable Form Ap-225 - Texas Sexually Oriented Business Fee Questionnaire printable pdf download

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Texas Sexually Oriented Business Fee

Questionnaire

General Information

Who Must Submit This Questionnaire - You must submit this questionnaire if you are a sole owner, partnership, corporation,

limited liability company, association or other legal entity that provides live nude entertainment or live nude perfor-

mances for an audience of two or more individuals and authorizes on-premises consumption of alcoholic beverages,

regardless of whether the consumption of alcoholic beverages is under a license or permit issued under the Alcoholic

Beverage Code.

Definitions -

“Nude” means:

(a) entirely unclothed; or

(b) clothed in a manner that leaves uncovered or visible through less than fully opaque clothing any portion of

the breasts below the top of the areola of the breasts, if the person is female, or any portion of the genitals

or buttocks.

“Sexually oriented business” means a nightclub, bar, restaurant or similar commercial enterprise that:

(a) provides for an audience of two or more individuals live nude entertainment or live nude performances; and

(b) authorizes on-premises consumption of alcoholic beverages, regardless of whether the consumption of

alcoholic beverages is under a license or permit issued under the Alcoholic Beverage Code.

These definitions may differ from local ordinances.

For Assistance - If you have any questions about this questionnaire, filing fee returns or any other fee-related matter, you

may contact the Texas State Comptroller’s field office in your area or call 1-800-252-5555 or 512-463-4600. Receive tax

help online at: https://

General Instructions -

• Write only in white areas.

• Complete this questionnaire and mail to: Comptroller of Public Accounts

111 E. 17th St.

Austin, TX 78774-0100

Federal Privacy Act - Disclosure of your social security number is required and authorized under law, for the purpose 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.

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 phone number listed on this form.

CLICK HERE TO BEGIN QUESTIONNAIRE

Legal name of owner (Same as Item 1 OR Item 5)

Date of signature(s)

18. The sole owner, all general partners, corporation president, vice-president, secretary or treasurer, managing director

Month

Day

Year

or an authorized representative must sign this questionnaire. The authorized representative must submit a written

power of attorney with questionnaire. (Attach additional sheets, if necessary.)

I (We) declare that the information in this document and any attachments is true and correct to the best of my (our) knowledge and belief.

Type or print name and title of sole owner, partner or officer

Sole owner, partner or officer

Type or print name and title of partner or officer

Partner or officer

Type or print name and title of partner or officer

Partner or officer

AP-133-1 (Rev.1-07/18)

Form AP-225 (Rev.5-13/3)

Form Ap-225 - Texas Sexually Oriented Business Fee Questionnaire

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