Form Ar-1r - Combined Business Tax Registration Form Page 7

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SECTION AF - WASTE TIRE
105.
a) Date Activity Begins in AR
b) DBA (if applicable)
a) Mailing Address (if different from Section B)
b) City
c) State
d) Zip Code
106.
SECTION AG - CONSTRUCTION
107.
a) Date Activity Begins in AR
b) DBA (if applicable)
a) Mailing Address (if different from Section B)
b) City
c) State
d) Zip Code
108.
SECTION AH - TELECOMMUNICATIONS
109.
a) Date Activity Begins in AR
b) DBA (if applicable)
110. PSC Permit Number
a) Mailing Address (if different from Section B)
b) City
c) State
d) Zip Code
111.
SECTION AI - MERCHANDISE VENDING (PLEASE COMPLETE SUPPLEMENTAL FORM)
112.
a) Date Activity Begins in AR
b) DBA (if applicable)
a) Mailing Address (if different from Section B)
b) City
c) State
d) Zip Code
113.
For MERCHANDISE VENDING please complete and attach form AR-1R-VEN.
SECTION AJ - AMUSEMENT (PLEASE COMPLETE SUPPLEMENTAL FORM)
114.
a) Date Activity Begins in AR
b) DBA (if applicable)
a) Mailing Address (if different from Section B)
b) City
c) State
d) Zip Code
115.
For AMUSEMENT please complete and attach form AR-1R-AMU.
SECTION AK - BINGO/RAFFLE (PLEASE COMPLETE SUPPLEMENTAL FORM)
116.
a) Date Activity Begins in AR
b) DBA (if applicable)
a) Mailing Address (if different from Section B)
b) City
c) State
d) Zip Code
117.
For BINGO/RAFFLE please complete and attach form
AR-1R-BRDM
or AR-1R-BRLAO.
SECTION AL - BEAUTY PAGEANT (PLEASE COMPLETE SUPPLEMENTAL FORM)
118.
a) Date Activity Begins in AR
b) DBA (if applicable)
a) Mailing Address (if different from Section B)
b) City
c) State
d) Zip Code
119.
For BEAUTY PAGEANT please complete and attach form AR-1R-BPG.
Revised 08/10/2012
Page 7 of 7

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