Form Ar-1r - Combined Business Tax Registration Form Page 5
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7SECTION O - OIL SEVERANCE
53.
a) Date Activity Begins in AR
b) DBA (if applicable)
54.
Please check the applicable classification.
Purchaser
Producer
a) Mailing Address (if different from Section B)
b) City
c) State
d) Zip Code
55.
SECTION P - TIMBER SEVERANCE
56.
a) Date Activity Begins in AR
b) DBA (if applicable)
57.
Please check the applicable classification.
Purchaser
Primary Processor/Producer
a) Mailing Address (if different from Section B)
b) City
c) State
d) Zip Code
58.
SECTION Q - OTHER SEVERANCE
59.
a) Date Activity Begins in AR
b) DBA (if applicable)
60.
Please check the applicable classification.
Purchaser
Producer
a) Mailing Address (if different from Section B)
b) City
c) State
d) Zip Code
61.
SECTION R - BEER
62.
a) Date Activity Begins in AR
b) DBA (if applicable)
63.
a) Please check the applicable classification.
Distributor Only
Native Brewery/Distributor
b) ABC Permit Number:
a) Mailing Address (if different from Section B)
b) City
c) State
d) Zip Code
64.
SECTION S - LIQUOR
65.
a) Date Activity Begins in AR
b) DBA (if applicable)
66.
a) Please check the applicable classification.
Manufacturer
Distributor/Wholesaler
b) ABC Permit Number:
a) Mailing Address (if different from Section B)
b) City
c) State
d) Zip Code
67.
SECTION T - WINE
68.
a) Date Activity Begins in AR
b) DBA (if applicable)
69.
a) Please check the applicable classification.
Distributor
Small Farm Winery
b) ABC Permit Number:
a) Mailing Address (if different from Section B)
b) City
c) State
d) Zip Code
70.
SECTION U - CIGARETTE
71.
a) Date Activity Begins in AR
b) DBA (if applicable)
72.
Please check the applicable classification.
Manufacturer
Wholesaler
Shipper Type #1:
Shipping Account Information:
73.
Shipper Type #2:
Shipping Account Information:
a) Mailing Address (if different from Section B)
b) City
c) State
d) Zip Code
74.
SECTION V - CIGARETTE PAPERS
75.
a) Date Activity Begins in AR
b) DBA (if applicable)
76.
Please check the applicable classification.
Retailer
Wholesaler
Manufacturer
a) Mailing Address (if different from Section B)
b) City
c) State
d) Zip Code
77.
Revised 08/10/2012
Page 5 of 7
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Parent category: Financial