Form 20dp - Nebraska Application For Direct Payment Authorization

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Nebraska Application for Direct Payment Authorization
FORM
20DP
Submit application with $10 application fee.
1 Your Nebraska ID Number
2 Federal Employer ID or Social Security Number
PLEASE DO NOT WRITE IN THIS SPACE
PRINT FORM
RESERT FORM
3 County of Business Location in Nebraska
NAME AND LOCATION ADDRESS
NAME AND MAILING ADDRESS
Name Doing Business As (dba)
Name
Legal Name
Street Address - Do Not Use PO Box
Street or Other Mailing Address
City
State
Zip Code
City
State
Zip Code
4 Accounting Period (Type of Tax Year)
(1)
Calendar – January 1 to December 31
(2)
Fiscal – 12 Month Ending
(3)
Fiscal – 52 or 53 Week Ending
5 Location of Books and Records
(1)
Same as Location Address
(2)
Same as Mailing Address
(3)
Other Address (Indicate below)
Address
City
State
Zip Code
6 Enter the estimated amount of your company’s annual Nebraska taxable purchases of property and services, excluding purchases for which a resale
certificate could be used.
$
7 Provide a general description of your business operations:
a. Business type:
Retailer
Lessor
Wholesaler
Manufacturer
Service Provider
Contractor
Farmer/Rancher
Other
b. If you sell a product or provide a service in Nebraska, describe the product or service:
8 Person to contact for information about your tax or tax accounting system.
(
)
Name
Title
Email
Phone Number
Under penalties of law, I declare that I have examined this application, and to the best of my knowledge and belief, it is correct
and complete. If the application is approved, I agree to accrue and pay to the Tax Commissioner on or before the 20th day of the
month following the date of purchase, lease, or rental, all sales and use taxes on purchases of taxable personal property and services.
I agree, as the holder of a direct payment permit, not to use it for cash purchases or for purchases of motor vehicles, motorboats,
lodging and related services, food and beverages, admissions, and items purchased for resale.
sign
(
)
here
Signature of Owners, Partner, Member, Corporate Officer, or
Title
Phone Number
Date
Person Authorized by Attached Power of Attorney
Who May File. Any company that has annual purchases in Nebraska of at least $3 million of taxable personal
property and services, excluding purchases for which a resale certificate could be used, may apply for direct
payment authorization. The application fee is $10 and is not refundable.
If this application is approved, you will be issued a Direct Payment Permit (DPP). The effective date will be
printed on the Permit. For additional information, refer to
Sales and Use Tax
Reg-1-097.
Whenever a name or address change occurs, you should request an updated DPP containing the new information.
Mail application and $10 fee to: NEBRASKA DEPARTMENT OF REVENUE, PO BOX 98903, LINCOLN, NE 68509-8903.
, 800-742-7474 (NE and IA), or 402-471-5729
3-2013
6-372-1997 Rev.
Supersedes 6-372-1997 Rev. 9-2011

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