Form 40003 - Oklahoma Retail Fireworks Registration Application
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4Form 40003
Revised 6-2013
Oklahoma Retail Fireworks Registration Application
OFFICE USE
ONLY
__________________________________________________________
_______________________
Business Name (same as Part 5, Item 1)
FEIN/SSN
Status:
Part 1 - Indicate the reason(s) for filing this form:
WTH
A
New Business
B
Additional License/Permit
C
Other (explain) ________________________________________________________
Sales Tax
Part 2 - Contact Information:
Approved
1. Business Phone: (
) __________________________________________________
2. Business Fax:
(
) __________________________________________________
3. Name: ____________________________________________________________________
COPO
4. Email Address: ______________________________________________________________
SIC Code
Part 3 - Ownership Type:
1. How is this business owned?
C
NAICS Code
A
B
Individual (Sole Proprietor)*
General Partnership
Limited Partnership
D
E
F
Oklahoma Corporation
Foreign Corporation
Limited Liability Company
G
Other (explain) _________________________________________________________________________
2. Federal Employer’s Identification Number (FEIN): ________________________________________________
3. Name of Individual, Partnership, Corporation or Limited Liability Company:
__________________________________________________________________________________________
Social Security Number, if individual: ___________________________________________________________
Mailing Address: ____________________________________________________________________________
City: _______________________________State: ______ Zip: ___________ County: ______________________
4. Physical Location of Entity: __________________________________________________________________
(street and number or directions, not post office box or rural route)
City: _______________________________State: ______ Zip: ___________ County: ______________________
5. Name(s) of Partner/Responsible Corporate Officer/Managing Member: (see instructions)
(If Social Security Number is not provided below, the application will be returned for completion.)
____________________________
__________
___________________________
_____________________
_________________________________
First Name
Middle Initial
Last Name
Social Security Number
Title
__________________________________________________________
_____________________________________
_______
____________________
Mailing Address
City
State
Zip Code
Attach separate sheet if necessary.
Part 4 - Wage Withholding Tax:
1. Do you now or do you intend to withhold Oklahoma Income Tax from employees? .......
Yes
No
(a) If “yes” on item 1, do you expect to withhold more than $500 per quarter? ...........
Yes
No
(b) If “yes” on item 1, date you will begin/began withholding Oklahoma Income Tax: ____________________
(month/day/year)
(c) Are you required to make federal withholding tax deposits more frequently
than once a month? ...............................................................................................
Yes
No
2. What FEIN will you use to report withholding tax?
(if different than
Part 3, Item 2)
Application continued on page B...
A
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Parent category: Financial