Form Cr-16 - Kansas Business Tax Application Page 3
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4ENTER YOUR EIN: ___ ___ __ ___ ___ ___ ___ ___ ___
OR
SSN: ___ ___ ___ __ ___ __ ___ ___ ___
PART 7
– CORPORATE INCOME TAX OR PRIVILEGE TAX
1. Date corporation began doing business in Kansas or deriving income from sources within Kansas: _____ _____ _____
2. What name and EIN will you be using to report federal income/expenses (if different than in Part 3, questions 2 and 6)?
Name: _______________________________________________________________
EIN: ___ ___ ___ ___ ___ ___ ___ ___ ___
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3. If your business is a financial institution, check the appropriate box:
Bank
Savings and Loan
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4. Check type of tax year:
Calendar Year
Fiscal Year
If fiscal year, provide year-end date: Month ________ Day ________
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5. If your business is a cooperative or political subdivision, check the appropriate box:
Cooperative
Political Subdivision
PART 8
– LIQUOR ENFORCEMENT TAX
1. Date of first sale of alcoholic liquor: _____ _____ _____
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2. Check type of license:
Liquor Store
Distributor
Microbrewery or Microdistillery
Other
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Farm Winery/Outlet
Special Order Shipping
Farmers Market Sales Permit
PART 9
– LIQUOR DRINK TAX
1. Date of first sale of alcoholic beverages:
_____ _____ _____
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2. Check type of license:
Class “A” or “B” Club
Public Venue
Caterer
Other
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Hotel or Hotel/Caterer
Drinking Establishment
Drinking Establishment/Caterer
PART 10
– CIGARETTE AND TOBACCO TAX
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1. Do you make retail sales of regular and/or electronic cigarettes over-the-counter, by mail, by phone, or over the internet?
No
Yes
If yes, you must enclose with this application a check or money order for $25.00 for each location and provide your e-mail or web
page address: ________________________________________________________________________________________________
2. If you sell regular cigarettes (not e-cigarettes), provide the name of your wholesaler(s): _____________________________________
3. If you sell electronic cigarettes, provide the name of your wholesaler(s): __________________________________________________
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4. Will you be the operator of cigarette vending machines?
No
Yes If yes, enclose Form CG-83 listing the machine brand name
and serial number for each machine, along with the DBA name and location address where each machine will be located. Also
enclose a check or money order for $25.00 for each machine.
5. Name of the company/corporation with whom you have a fuel supply agreement/retailing agreement (e.g., Shell, BP, Phillips 66,
Conoco): ____________________________________________________________________________________________________
PART 11
– NONRESIDENT CONTRACTOR
(See instructions)
If registering for more than one contract, enclose a separate page for each contract.
1. Total amount of this contract: $ ______________
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2. Required bond:
$1,000
8% of Contract
4% of Contract (enclose a copy of the project exemption certificate)
3. List who contract is with: ___________________________________________
Phone: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
4. Location of Kansas project (include apartment, suite, or lot number): ____________________________________________________
City ____________________________________ County __________________ State ___________ Zip Code ________________
5. Starting date of contract: _____ _____ _____
Estimated contract completion date: _____ _____ _____
6. Subcontractor’s name (If more than one, enclose an additional page): ____________________________________________________
Street Address ____________________________ City _______________________ State _________ Zip Code _______________
7. Subcontractor’s EIN:
___ ___ __ ___ ___ ___ ___ ___ ___
8. Subcontractor’s portion of contract: $ _______________________________
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