Form Ap-225 - Texas Sexually Oriented Business Fee Questionnaire Page 2
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1
2AP-225
Texas Sexually Oriented
(Rev.5-13/3)
Business Fee Questionnaire
Page 1
• Type or print.
• Do not write in shaded areas.
SOLE OWNER IDENTIFICATION
1. Name of sole owner (First, middle initial and last name)
2. Social security number (SSN)
3. Taxpayer number for reporting any Texas tax OR Texas identification
Check here if you DO NOT
number if you now have or
have a SSN.
have ever had one.
NON-SOLE OWNER IDENTIFICATION
--- All sole owners skip to Item 9. ---
4. Business organization type
Profit Corporation (CT, CF)
General Partnership (PB, PI)
Business Trust (TF)
Please submit a copy of the trust
Nonprofit Corporation (CN, CM)
Professional Association (AP, AF)
Trust (TR)
agreement with this questionnaire.
Limited Liability Company (CL, CI)
Business Association (AB, AC)
Real Estate Investment Trust (TH, TI)
Limited Partnership (PL, PF)
Joint Venture (PV, PW)
Joint Stock Company (ST, SF)
Professional Corporation (CP, CU)
Holding Company (HF)
Estate (ES)
Other legal entity (explain)
5. Legal name of partnership, company, corporation, association, trust or other entity
6. Taxpayer number for reporting any Texas tax OR Texas identification number if you now have or have ever had one.
1
7. Federal employer identification number (FEIN) assigned by the Internal Revenue Service ........................................
3
8.
Check here if you do not have a FEIN. .......................................................................................................................
9. Mailing address
Street number, P.O. Box or rural route and box number
City
State/province
ZIP code
County (or country, if outside the U.S.)
10. Name of person to contact regarding day to day business operations
Daytime phone
If you are a SOLE OWNER, skip to Item 16.
File number
Month
Day
Year
11. If the business is a Texas profit corporation, nonprofit corporation, professional corporation,
limited liability company or any other legal entity, enter the file number and date. ..........................
12. If the business is a non-Texas profit corporation, nonprofit corporation, professional corporation, limited liability company or any other legal entity,
enter the state or country of incorporation, file number and date, Texas Certificate of Authority number and date.
Texas Certificate of Authority number
State/country of inc.
File number
Month
Day
Year
Month
Day
Year
YES
NO
13. If the business is a corporation, has it been involved in a merger within the last seven years?
(If “YES,” attach a detailed explanation.)
State
Number
14. If the business is a limited partnership or registered limited liability
partnership, enter the home state and registered identification number. ...........................................................
15. General partners, principal members/officers, managing directors or managers
(ALL GENERAL PARTNERS MUST BE LISTED - Attach additional sheets, if necessary.)
Name
Title
Phone (Area code and number)
Home address
City
State
ZIP code
Date of birth
SSN or FEIN
Driver license number
State
County (or country, if outside the U.S.)
Percent of
Month
Day
Year
ownership _______ %
Position held
Partner
Officer
Director
Corporate Stockholder
Record keeper
Name
Title
Phone (Area code and number)
Home address
City
State
ZIP code
Date of birth
SSN or FEIN
Driver license number
State
County (or country, if outside the U.S.)
Percent of
Month
Day
Year
ownership _______ %
Position held
Partner
Officer
Director
Corporate Stockholder
Record keeper
16. Business location name and address (Attach additional sheets for each additional location.)
Business location name
City
State
ZIP code
County
Street and number (Do not use P.O. Box or rural route)
Month
Day
Year
17. Enter date of first business operation in the above location that is subject to the Texas Sexually Oriented Business Fee. .......
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