Form 20 - Nebraska Tax Application

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Important Message
Nebraska Tax Application
FORM
20
Please attach a check for those programs listed in section 15 that require a fee.
1 Do you hold, or have you previously held a Nebraska
3 County of Business Location Within
PLEASE DO NOT WRITE IN THIS SPACE
ID number?
Nebraska
YES
NO
If Yes, provide the number:
RESET FORM
PRINT FORM
2 Federal Employer ID Number
4 For Department Use Only
NAME AND LOCATION ADDRESS OF BUSINESS
(print clearly)
NAME AND MAILING ADDRESS
Name Doing Business As (dba)
Name
Legal Name
Business Street Address (Do Not Use PO Box)
Street or Other Mailing Address
City
State
Zip Code
City
State
Zip Code
5 Name and Address of Legal Entity/Owner
Is your Nebraska location within the city limits?
(1)
YES
(2)
NO
6 Identify Owner and Spouse (if joint ownership), Partners, Members, or Corporation Officers (one of the listed individuals must sign as applicant).
Social Security Number
Name, Address, City, State, Zip Code
Title, If Corporate Officer
7 Type of Ownership
(1)
Sole Proprietorship
(5)
Foreign Corporation (another state or country)
(9)
Nonprofit Organization
(2)
Partnership
(6)
S Corporation
(10)
Cooperative
(3)
Nonprofit Corporation
(7)
Governmental
(11)
Limited Liability Company
(4)
Corporation
(8)
Fiduciary (Estate or Trust)
8 Accounting Basis
9 Accounting Period (Type of Year) (see instructions)
(1)
Cash
(1)
Calendar – January 1 to December 31
(2)
Accrual
(2)
Fiscal – 12 Month Ending
(3)
Other
(3)
Fiscal – 52 or 53 Week Ending
10 Location of Records
(1)
Same as Location Address
(3)
Other Address (provide below)
(2)
Same as Mailing Address
Address
City
State
Zip Code
11 Reason for Filing Application – Check Appropriate Boxes. If Box 3 is checked, you may cancel your old Nebraska ID number on the final
return, on a Form 22, or by providing the number and final date in Box 3 below.
(1)
Original Application
(3)
Changed Business Entity (To cancel Nebraska ID number (4)
Renewal-Cigarette Dealers Only
(2)
Change in Partners
of previous entity, write the ID number and final date here: (5)
Add Tax Program
ID #_________________________ Date_____________) (6)
Other (attach explanation)
From -
To -
Sole Proprietorship
Sole Proprietorship
Partnership
Partnership
Limited Liability Company
Limited Liability Company
Corporation
Corporation
12 Provide a description of your business operations and products or services sold.
a. Primary business type:
Retailer
Lessor
Wholesaler
Manufacturer
Other
If you marked “Lessor”, do you lease motor vehicles to others for periods of longer than 31 days?
YES
NO
b. If your business does not operate year-round, identify the months you operate.
c. How many business establishments do you operate: in Nebraska?
in U.S.A.?
d. If you purchased an existing business, identify the previous owner.
Name
Address
City
Zip Code
Nebraska ID Number
COMPLETE REVERSE SIDE
9-2012
7-100-1975 Rev.
Supersedes 7-100-1975 Rev. 4-2012

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