Form 027 - Wyoming Sales/use Tax License Application Direct Pay Permit
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1*0-0-206-001*
*0-0-206-001*
Wyoming Department of Revenue
Excise Tax Division
Department Use Only
122 W. 25th Street, Herschler Bldg.
NAICS_____________________
Cheyenne, Wyoming 82002-0110
RID________________________
Permit#_____________________
Approved by:_________________
Sales/Use Tax License Application
_
Date:_______________________
Direct Pay Permit
1. Business Name or DBA: _______________________________________________________________________________
2.
Mailing Address: _____________________________________________________________________________________
Street or Box No.
City
State
Zip Code
3.
Location Address: ____________________________________________________________________________________
Street
City
State
Zip Code
4. Is this business located within the boundaries of an incorporated city or town in Wyoming?
Yes
No
5. Does this company have a physical location in this state?
Yes
No
6. Internet E-mail
7. Business Telephone Number: (
)_____-___________ (800)______-___________Fax No.(
)______-____________
8. Authorized person to contact regarding sales tax matters ____________________________(
)____-____________
9. Estimated monthly purchases volume?
$_______________________
10. Describe the type of products or Services you provide:_______________________________________
11. Does this business have more than one location in Wyoming?
If Yes, how many?__________
Yes
No
12. Would you prefer to file a consolidated return for all locations?
Yes
No
If yes provide a list of the Wyoming Sales/Use Tax License numbers you would like to report on the consolidated return.
13. Please check one of the following to best describe your ownership: *(spousal ownership is considered a partnership)
(A) _____ Individual
(F) _____ Limited Liability Limited Partnership (LLLP)
(B) _____ General Partnership
(G) _____Corporation
(C) _____ Limited Partnership
(H) _____ 'S' Corporation
(D) _____ Limited Liability Company (LLC)
(I) _____ Association
(E) _____ Limited Liability Partnership(LLP)
(J) _____ Joint Venture
Corporation (1)______________________(2)_________________(3)_____________________________
(Corporate Name)
(federal identification number)
(date and state incorporated)
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 until this information is provided.
14. SIGNATURE AND DECLARATION:
An authorized employee, officer, partner, member or owner of the taxpayer identified above must sign and return this form. Attach any
appropriate power of attorney statement.
I understand and agree to the terms of this statement. I understand this agreement incorporates any statements made in the application and
attachments. I certify that the accounting system and procedures in place will adequately identify, individually report and remit all taxes
owed.
By
Title
Typed name
Date
Basis of Authority to Sign
Please Mail To: Wyoming Department of Revenue, 122 West 25th Street, Cheyenne, WY 82002-0110
ETS Form 027 (Revised 4/25/11)
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