Form S-1 - Vermont Application For Business Tax Account (Page 4 of 7) in pdf

PART 5 - CORPORATE INCOME TAX OR BUSINESS INCOME (ENTITY) TAX

Start Date (see instructions) _______ / ______ / ___________ Fiscal Year End ____________________

Person to contact about Vermont Corporate Income or Business Income (Entity) Tax account:

Name ________________________________________________________________________________________

Telephone number: _____________________________

Fax number: ______________________________

e-mail address: ________________________________________________________________________________

Mailing Address for Corporate Income or Business Income (Entity) Tax account returns and information (if different from Part 1 address):

____________________________________________________________________________________________

Street, Road or PO Box

City/Town

State

ZIP Code

Physical Location of Business: _____________________________________________________________

(Street address only - No PO Boxes)

______________________________________________________________________________________

City/Town

State

ZIP Code

Records Location: _________________________________________________________________________________

If part of a federal consolidated group, enter the name and EIN of the parent. If S-Corporation, include Form 2553.

_______________________________________________________________________________________________

PART 6 - OTHER TAXES

Fuel Gross Receipts

Start Date ____________________________________

Telecommunications

Start Date ____________________________________

Local Option Tax(es)

Start Date ____________________________________

Local Option Town(s)

____________________________________________

PART 7 - PREVIOUS OWNERSHIP

Name and address of previous owner:

____________________________________________

Date you purchased business: _____ / ____ / _________

____________________________________________

Date of 32 V.S.A. ß3260 Notice: ____ / _____ / ________

____________________________________________

PART 8 - CERTIFICATION

I certify under pains and penalty of perjury this application is true, correct and complete to the best of my

knowledge.

Signature ___________________________________________

Title ________________________________

Name _____________________________________________

Date ________________________________

(Please print)

Send or fax completed application to:

Vermont Department of Taxes

PO Box 547

Montpelier, VT 05601-0547

Telephone: (802) 828-2551

Fax: (802) 828-5787

Form S-1 - Vermont Application For Business Tax Account Page 4

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