Instructions For Form Ar-1rarkansas Combined Business Registration Form (Page 3 of 5) in pdf

SECTION J – PARTNERSHIP

SECTION M – BRINE

SECTION Q – OTHER

INCOME

SEVERANCE

Line 33 a) Enter the date that Arkansas

Line 59 a) Enter the start date

Line 48 a) Enter the start date

Partnership Income started or will begin. b)

(

) you became an

(MM/DD/YYYY) you became an

MM/DD/YYYY

Enter the Doing Business As (DBA) name. If

Operator/Producer and/or First Purchaser in

the DBA name is exactly the same as the

Arkansas. If you do not know the date, an

legal name, leave this line blank.

estimated start date is allowable. b) Enter

the Doing Business As (DBA) name. If the

Line 34 a-d) Enter the mailing address if

DBA name is exactly the same as the legal

different from Section B.

name, leave this line blank.

Line 49 Indicate the applicable

Line 60 Indicate the applicable

SECTION K - MOTOR FUEL

classification, Producer or Purchaser.

Line 35 a) Enter the date that you started

Line 50 a-d) Enter the mailing address if

Line 61 a-d) Enter the mailing address if

purchasing or importing fuel into Arkansas.

different from Section B.

If you do not know the actual date, then

estimate the opening date. b) Enter the

SECTION N – NATURAL

SECTION R – BEER

DUNS Number. c) Enter your Doing

Business As (DBA) name. If the DBA name

GAS SEVERANCE

is exactly the same as the legal name,

Line 62 a) Enter the start date

leave this line blank.

(MM/DD/YYYY) you became a Distributor

Line 51 a) Enter the start date

and/or Native Brewery/Distributor in

(MM/DD/YYYY) you became an

Line 36 a-d) Enter the mailing address if

Arkansas. If you do not know the date, an

Operator/Producer and/or First Purchaser

different from Section B.

estimated start date is allowable. b) Enter

in Arkansas. If you do not know the date, an

the Doing Business As (DBA) name. If the

estimated start date is allowable. b) Enter

Line 37 Indicate the types of fuels you

DBA name is exactly the same as the legal

the Doing Business As (DBA) name. If the

intend to import/export or purchase for

name, leave this line blank.

DBA name is exactly the same as the legal

resale or distribution in Arkansas.

name, leave this line blank. c) Indicate the

Line 63 a) Indicate the applicable

applicable classification, Producer or

Line 38 Indicate which method you will use

classification, Distributor or Native

Purchaser. d) Enter your Arkansas Oil/Gas

if importing or exporting fuel into Arkansas.

Brewery/Distributor. b) Enter your ABC

Operator Number (if applicable).

Permit Number.

Line 39 Indicate YES or NO if you

Line 52 a-d) Enter the mailing address if

transport petroleum in any device having a

Line 64 a-d) Enter the mailing address if

different from Section B.

carrying capacity exceeding 9,500 gallons.

different from Section B.

SECTION O – OIL

Line 40 a) Indicate YES or NO if you

SECTION S – LIQUOR

SEVERANCE

previously held a Motor Fuel Tax license in

Arkansas. b) If yes, please enter your

Line 65 a) Enter the start date

previous license number.

Line 53 a) Enter the start date

(MM/DD/YYYY) you became a Manufacturer

(MM/DD/YYYY) you became an

and/or Wholesaler in Arkansas. If you do not

Line 41 Indicate YES or NO if you are

Operator/Producer and/or First Purchaser

know the date, an estimated start date is

acquiring an existing business that held a

in Arkansas. If you do not know the date,

allowable. b) Enter the Doing Business As

Motor Fuel Tax license.

an estimated start date is allowable. b)

(DBA) name. If the DBA name is exactly the

Enter the Doing Business As (DBA) name.

same as the legal name, leave this line

Line 42 a) If yes, please enter the name of

If the DBA name is exactly the same as the

blank.

the company that you acquired and b) the

legal name, leave this line blank.

account number.

Line 66 a) Indicate the applicable

Line 54 Indicate the applicable

classification, Manufacturer or

Line 43 Indicate YES or NO if you have

classification, Producer or Purchaser.

Distributor/Wholesaler. b) Enter your ABC

any bulk storage facilities in Arkansas.

Permit Number.

Line 55 a-d) Enter the mailing address if

Line 44 Indicate the estimated number of

different from Section B.

Line 67 a-d) Enter the mailing address if

gallons of fuel to be reported in the State of

different from Section B.

Arkansas each month for a) gasoline and

SECTION P – TIMBER

b) diesel.

SECTION T – WINE

SEVERANCE

Line 45 Indicate which business activities

Line 68 a) Enter the start date

Line 56 a) Enter the start date

may apply to your company if you are

(MM/DD/YYYY) you became a Distributor

(MM/DD/YYYY) you became an

granted a license.

and/or Small Farm Winery in Arkansas. If

Operator/Producer and/or First Purchaser

you do not know the date, an estimated start

in Arkansas. If you do not know the date,

SECTION L – DYED DIESEL

date is allowable.

an estimated start date is allowable. b)

Enter the Doing Business As (DBA) name.

Line 46 a) Enter the date that you started

Line 68 b) Enter the Doing Business As

If the DBA name is exactly the same as the

purchasing or importing diesel fuel into

(DBA) name. If the DBA name is exactly the

legal name, leave this line blank.

Arkansas. If you do not know the actual date,

same as the legal name, leave this line

please estimate the opening date. b) Enter

blank.

Line 57 Indicate the applicable

the Doing Business As (DBA) name. If the

classification, Primary Processor/Producer

DBA name is exactly the same as the legal

Line 69 a) Indicate the applicable

or Purchaser.

name, leave this line blank.

classification, Distributor or Small Farm

Line 58 a-d) Enter the mailing address if

Winery. b) Enter your ABC Permit Number.

different from Section B.

Line 47 a-d) Enter the mailing address if

Line 70 a-d) Enter the mailing address if

different from Section B.

Revised 01/30/2013

Page 3 of 5

Instructions For Form Ar-1rarkansas Combined Business Registration Form Page 3

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