Form S-1 - Vermont Application For Business Tax Account

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VERMONT
VT ID NUMBER
F
APPLICATION FOR
FOR DEPARTMENT USE ONLY
BUSINESS TAX ACCOUNT
TYPE OR PRINT - Please read instructions and answer applicable questions completely.
PART 1 - APPLICANT INFORMATION
1A - Type
Sole Proprietor (Individual, Husband/Wife or Civil Union owners)
Partnership
LLC
S-Corporation
C-Corporation
501(c)(3)
Federal Government
VT State Government
Other Government
Other ____________________________________
1B - Name: ___________________________________________________________________________________
Full Legal Name of Proprietor (Last, First, Middle), Corporation, Partnership, etc.
-
-
-
1C - Identification Numbers:
Federal Employer Identification Number
Social Security Number (for Sole Proprietorship only)
1D - Mailing Address: ______________________________________________________________________
Street, Road or PO Box
_________________________________________________________________________________________
City/Town
State
ZIP Code
1E - Date authorized to do business in Vermont by Vermont Secretary of State: _____ / _____ / ___________
(For LLC, S or C Corporation, or Partnership)
State of Incorporation: _______________
1F - Business Principals with Fiscal Responsibility
Title ____________________________________________
SSN ___________________________
Name __________________________________________________________________________________
Last Name
First Name
Middle Name
Address ________________________________________________________________________________
Title ____________________________________________
SSN ___________________________
Name __________________________________________________________________________________
Last Name
First Name
Middle Name
Address ________________________________________________________________________________
Title ____________________________________________
SSN ___________________________
Name __________________________________________________________________________________
Last Name
First Name
Middle Name
Address ________________________________________________________________________________
Title ____________________________________________
SSN ___________________________
Name __________________________________________________________________________________
Last Name
First Name
Middle Name
Address ________________________________________________________________________________
Attach listing on separate piece of paper if more business principals.
Form S-1
(Rev. 6/04)
1

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