Form Acd-31015 - Application For Business Tax Identification Number

STATE OF NEW MEXICO – TAXATION AND REVENUE DEPARTMENT

ACD - 31015

APPLICATION FOR BUSINESS TAX IDENTIFICATION NUMBER

Rev 08/07

PLEASE TYPE OR PRINT IN BLACK INK – Please read instructions on reverse

For office use only

DATE ISSUED

NTTC ONLY

NM TRD ID# 0____-_____________-00-___

FLAG N

1. BUSINESS NAME

2. DBA

3. Federal ID No.

7. Type of Ownership (check one)

Corporation

Non Profit Organization

Required except for Individual / Proprietorship / Sole Owner

Estate

Exempt 501 (c) ________

Government

Partnership

4. Telephone- Business (

)

Indian Tribe

General

Limited

Individual / Proprietorship / Sole Owner

S Corporation

5. Other (

)

Fax (

)

Limited Liability Company (LLC)

Trust

6. Business E-mail Address

8. Mailing Address

City

State

Zip Code

9. Principal Business Location

City

State

Zip Code

10. Date business activity started or is anticipated to start in New Mexico

11. Date business will close (only if you check “Temporary” in box 12)

Month

Day

Year

Month

Day

Year

12. Select CRS Filing status:

13 A. Will business pay wages to employees in New Mexico?

Yes

No

Monthly

Quarterly

Semiannual

13 B. Will business be required to obtain Worker’s Compensation

Temporary

Seasonal

Insurance within 12 months?

Yes

No

If seasonal, indicate month(s) in which you will file:

Effective date:

14. List Owners, Partners, Corporate Officers, Association Members, or Shareholders. If listing a business other than an individual, please see instructions.

(Attach additional pages if necessary.)

SSN / ITIN / FEIN __________________________________________________________________

SSN / ITIN / FEIN __________________________________________________________________

(required)

(required)

Name & Title

____________________________________________________________________

Name & Title

____________________________________________________________________

Home Address

____________________________________________________________________

Home Address

____________________________________________________________________

Phone

____________________________________________________________________

Phone

____________________________________________________________________

E-Mail

____________________________________________________________________

E-Mail

____________________________________________________________________

15. Method of accounting

16. Liquor License Type and No.

17. Public Regulatory Commission No.

18. Contractor’s License No.

Cash

Accrual

19. Will business sell Gasoline?

Yes

No

23. Will business engage in Severing Natural Resources?

Yes

No

20. Will business sell Special Fuels?

Yes

No

24. Will business engage in Processing Natural Resources?

Yes

No

21. Will business sell Cigarettes?

Yes

No

25. Will business be a Water Producer?

Yes

No

22. Will business sell Tobacco Products?

Yes

No

26. Will business be involved in Gaming Activities?

Yes

No

NOTE: If you answered Yes to any of the above, except Gaming Activities, please complete a Special Tax Registration Form.

27. If applicable, provide former owner’s

28. Are you operating any other business (es) in New Mexico?

Yes

No

NM TRD ID No. __________________________________________________

If yes, give: NM TRD ID No. _________________________________________

Business Name____________________________________________________

Business Name ____________________________________________________

29. Primary type of business in NM (Check all that apply)

30. Give a brief description of nature of

Accommodation, Food Services, and Drinking Places

Manufacturing

business

Administrative and Support Services and

Mining and Oil and Gas Extraction

Waste Management and Remediation Services

Professional, Scientific and Technical Services

Agriculture, Forestry, Fishing and Hunting

Real Estate and Leasing of Real Property

Arts, Entertainment and Recreation Management

Rental and Leasing of Tangible Personal

Construction

Property

Educational Services

Retail Trade

Finance and Insurance

Transportation and Warehousing

Government

Utilities

Health Care and Social Assistance

Wholesale Trade

Information

Other Services

31.

I declare that the information reported on this form and any attached supplement(s) is true and correct

.

______________________________________________________________________________________________________________________ ______________________________________ ____________________

Print Name

Title

Date

______________________________________________________________________________________________________________________

Signature