Form 001vd - Sales And Use Tax License Application Voluntary Disclosure Page 5
ADVERTISEMENT
1
2
3
4
5
6*0-0-0-001*
Wyoming Department of Revenue
*0-0-0-001*
Excise Tax Division
122 W. 25th Street, Herschler Bldg.
Cheyenne, Wyoming 82002-0110
Voluntary Disclosure
1.
Application Date:_
2.
Ownership Name:_
(1)
( federal identification number)
3.
DBA/Doing business as:
(1)
(
date and state of incorporation)
4.
Please check one of the followng to best describe your ownership:
A.
_Association/Club
B.
Corporation C._
Individual D.
_Limited Partnership
E. Limited Liability Company F._
Partnership G._
Other (explain)
5.
Mailing Address:
Street or Box No.
City
State
Zip Code
Location Address:
6.
Street
City
State
Zip Code
7.
Internet E-mail Address_
_@
8.
Business Telephone Number: (
)_
_-_
(800)
_-
_Fax No.(
)
-
9.
Authorized contact
_(
)_
-
Name
Phone number
10. What type of sales does this business make? Wholesale_
Retail_
_Services_
Maunfacturer_
11. Estimated monthly sales volume: $
12. Describe specifically the type of products you sell, (Examples: auto parts, computers, vitamins) and/or services you
provide, (Examples: auto repair, computer repair) and the percent of the total sales each type represents [Example:
(must equal 100%) motel 50%, restaurant 30%, bar 20%]
(A)
%
(B)
%
(C)_
%
(D)
%
13. Is this business located within the boundaries of an incorporated city or town in Wyoming?
Yes
No
14. Does this company have a physical location in this state?
Yes
No
15. Does your company make deliveries into this state with your own vehicles?
Yes
No
16. Do you extend or arrange for the extension of consumer credit?
Yes
No
17. Do you have employees, sales representatives, or other agents working temporarily or
Yes
No
permanently in the State?
Note: Corporations, limited partnerships, and limited liability companies must provide evidence of registration with
the Wyoming Secretary of State's Office (307) 777-7311). Corporations must attach a complete list of officers.
Limited liability companies must attach a complete list of members or managers. Licensing will be delayed
until this information is provided.
ETS Form 001VD (Revised 4/25/11)
Page 1 of 2
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial