Fillable Form Blt: Str-1 - Severance Tax Registration printable pdf download

Form Blt: Str-1 - Severance Tax Registration

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Type account registering for: (check all

BLT: STR-1

LABAMA

EPARTMENT OF

EVENUE

08/2012

that apply)

& L

USINESS

ICENSE

IVISION

AUST

___

Producer

& L

EVERANCE

ICENSE

ECTION

___

Purchaser

P.O. Box 327560 • Montgomery, AL 36132-7560 • (334) 353-7827

___ Coal

Severance Tax Registration

Forest

___

Severer

Alabama Uniform Severance Tax – Section 40-13-56

___

Processor

Coal Severance – Sections 40-13-3 and 40-13-34

___ Iron Ore

Forest Severance – Section 9-13-86

___ Local Solid Mineral

Iron Ore – Section 40-12-128

Reset

Oil & Gas

Local Solid Minerals – Various Acts

___

Producer

Oil & Gas Severance Tax – Sections 40-20-4 and 9-17-25

___

Purchaser

PLEASE TYPE OR PRINT LEGIBLY.

___

Offshore

ANSWER ALL QUESTIONS APPLICABLE TO YOUR BUSINESS.

1. LEGAL NAME OF BUSINESS

6. BUSINESS PHONE

7. FEDERAL I.D. NO./SOCIAL SECURITY NO.

(

)

2. TRADE NAME (D/B/A)

8. BUSINESS LOCATION (STREET)

3. MAILING ADDRESS (STREET OR P.O. BOX)

9. BUSINESS LOCATION (CITY & ZIP CODE)

–

10. TYPE OF ORGANIZATION

Individual

Partnership

4. CITY

STATE

ZIP CODE

Corporation (attach copy of certificate of incorporation)

–

5. COUNTY IN WHICH BUSINESS ADDRESS IS LOCATED

LLC (must answer election question)

Election made on IRS Form 8832?

Yes (attach copy)

11. REASON FOR APPLYING

Change of Ownership

Change in Business Structure

12. DATE BUSINESS

13. NAME OF FORMER OWNER OF BUSINESS, IF

BEGAN IN ALABAMA

APPLICABLE

New Business

Other

List below names, social security numbers, titles, and home addresses of owner, partners, corporate officers, or LLC member(s). Attach listing if space is not sufficient.

NAME

SSN/FEIN

TITLE

ADDRESS

Signature(s) of owner, all partners, corporate officers or LLC member(s) is/are required.

NAME 1

TITLE

DATE

NAME 2

TITLE

DATE

NAME 3