Income Tax Withholding Tables And Instructions For Employers Page 62
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69NC-BR
Business Registration Application for
Office Use
Income Tax Withholding, Sales and Use Tax,
Web
10-11
and Machinery and Equipment Tax
North Carolina Department of Revenue
1. Federal Employer ID No.:
or Proprietor’s Social Security No.:
2. Type of Ownership:
Proprietorship
Corporation
LLC
Partnership
LLP
Fiduciary
Other (Specify)
If a corporation, state of incorporation:
If Corporation or LLC, enter N.C. Secretary of State ID No., if applicable:
3. Legal Business or Owner’s Name:
4. Trade Name (DBA Name):
5. Daytime Business Phone:
6. Fax Phone:
Street
7. Business Location in N.C.:
(Not P.O. Box Number)
State
City
Zip Code
County
8. Is the business located within city or town limits?
Yes
No
9. Number of locations in N.C. Enclose list if more than one.
10. Mailing Address:
Street or P.O. Box
State
City
Zip Code
11. List responsible persons (President, Treasurer, Chief Financial Officer, Manager, Primary Partners, other officers, etc.):
Title
Address
Social Security No.
Name
Complete to apply for an Income Tax Withholding Number.
-Do you have employees who are subject to N.C. withholding?
Yes
No
-Date when wages were or will first be paid in N.C.:
(You are required to file a return beginning with the month or quarter you indicate.)
Yes
No
-Do you make pension payments to N.C. residents?
If yes, do you choose to report the pension payment withholding separately? (See instructions)
Yes
No
-Do you pay compensation (other than wages to employees) to a nonresident entity or a nonresident individual for personal services performed
in N.C.?
Yes
No
-Do you pay compensation (other than wages) to an ITIN contractor for services performed in N.C.?
Yes
No
-Total amount you expect to withhold each month: Less than $250 (Quarterly) $250 - $2,000 (Monthly) more than $2,000 (Semiweekly)
Jan
Feb
Mar
Apr
May Jun
Jul
Aug
Sep
Oct
Nov
Dec
-If your business is seasonal, fill in circles for months employees are paid:
Complete to apply for a Sales and Use Tax Number.
(You are required to file a return beginning with
-When will you start selling or purchasing items subject to N.C. sales or use tax?
the month or quarter you indicate.)
-Will your sales be? Retail (to users or consumers) Wholesale (to registered merchants for resale) Both Retail and Wholesale
-What kind of business do you operate? (Be specific)
-What accounting method will you use?
Cash
Accrual
-Are you registering only to remit use tax on purchases?
Yes
No
-Will you provide and sell electricity?
Yes
No
-Will you provide and sell telecommunications services?
Yes
No
-Will you lease motor vehicles to others?
Yes
No
-Will you provide and sell direct-to-home satellite services?
Yes
No
-Will you sell new tires?
Yes
No
Yes
No
-Will you provide and sell other video programming services?
-Will you sell new appliances?
Yes
No
-Amount of sales tax expected each month: Less than $100 (Quarterly) $100 - $20,000 (Monthly) $20,000 or more (Monthly with Prepayment)
-If your business is seasonal, fill in circles for months of sales:
Jan
Feb
Mar
Apr
May Jun
Jul
Aug
Sep
Oct
Nov
Dec
IV. Machinery and Equipment Tax Section -
Complete to apply for a number to remit tax on purchases of machinery and equipment.
Yes
No
-Are you registering to remit tax on purchases of machinery or recycling equipment to operate a manufacturing industry or plant?
-When will you begin making these purchases?
V. Signature:
Title:
Date:
I
certify that, to the best of my knowledge, this application is accurate and complete.
Mail to: N.C. Department of Revenue, P. O. Box 25000, Raleigh, NC 27640-0100
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