Fillable Form R-1 - Business Registration Form (Page 7 of 8) in pdf

Mailing Address – enter a mailing address specific for Pass-Through Entity reporting information.

Check here if same as the Primary Mailing Address on page 3.

Address or PO Box __________________________________________________________

City

__________________________

State ______

ZIP Code ______________

Contact Information – identify a contact person specific to Pass-Through Entity information.

Check here if same as the Primary Business Contact on page 3.

Name ______________________________________

Phone Number _______________________

Responsible

Party - Attach a list of the Responsible Parties associated with this Business and include each person’s

name, social security number, and relationship to the business, title, effective date the person’s responsibility started, and

the person’s residence address and home phone number. Under Section 58.1-1813 of the Code of Virginia, any corporate,

partnership, or limited liability officer may be held personally liable for unpaid taxes assessed against a corporation or

partnership. The term “corporate, partnership, or limited liability officer” includes any officer or employee of a corporation, or

a member, manager, or employee of a partnership or limited liability company, who is under a duty to collect and to account

for and pay the assessed tax, who had knowledge of the failure to pay the tax, and who had the authority to prevent the

failure.

MISCELLANEOUS TAXES

Identify if your Business will be responsible for remitting any of the following taxes and the effective date you

became liable for the tax (MM/DD/YY):

Litter Tax

Effective Date

_______________

This tax is paid by every business in the state that, on January 1 of the taxable year, was engaged as the

manufacturer, wholesaler, distributor, or retailer of the following products: food for human or pet consumption;

groceries; cigarettes and tobacco products; soft drinks and carbonated waters; beer and other malt beverages;

wine; newspapers and magazines; paper products and household paper; containers made of glass, metal, or

plastic; fiber containers made of synthetic material; cleaning agents and toiletries; non-drug drugstore sundry items;

distilled spirits; and motor vehicle parts.

Soft Drink Excise Tax

Effective Date

_______________

This tax is levied on every wholesaler or distributor of carbonated soft drinks in Virginia.

Forest Products Tax

Effective Date

_______________

This tax is levied on every person in Virginia engaging in the business of manufacturing, shipping, or severing

timber or any other forest products from the soil for sale, profit, or commercial use.

Motor Vehicle Rental Tax

Effective Date

_______________

This tax is levied on the rental of motor vehicles in Virginia, whether from a rental business or from an automobile

dealership or other establishment, for a period of less than 12 months.

Egg Excise Tax

Effective Date

_______________

This tax is levied on shell eggs and egg products sold or consumed in Virginia. The handler of such eggs is

responsible for collecting and remitting the tax. Generally, the last handler who sells eggs to a Virginia retailer or

food service establishment is liable for the tax.

Corn Assessment

Effective Date

_______________

This assessment is levied on corn produced in Virginia for sale. The handler (including any farmer who sells his or

her corn out of state) is responsible for payment of the assessment. It is deducted from payments to farmers for

corn purchased.

Form R-1 - Business Registration Form Page 7

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