Form Cd-3 - New Hampshire Application For Meals & Rentals Tax Operators License
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NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
CD-3
APPLICATION FOR MEALS & RENTALS TAX
055
License Number
OPERATORS LICENSE
LICENSE REQUIRED BEFORE OPERATING
Date Issued
Filing Requirements
TYPE OR PRINT CLEARLY
1
BUSINESS / TRADE NAME
Activity Code
2
NAME OF OWNER
Secretary of State Business ID #
3
MAILING ADDRESS
MAILING ADDRESS CONTINUED
E-MAIL ADDRESS
4
CITY OR TOWN
5
STATE
ZIP CODE + 4
6(a)
Type of Business Entity:
Proprietorship
Corporation
Partnership
Fiduciary
Non-Profit
5
1
2
3
4
Is the Business Entity an LLC?
Yes
No If yes, list LLC Managing Member’s Name:
6(b)
7
Federal Employer Identification Number of the above business: FEIN:
(Do Not Enter SSN Here)
8
Federal Employer Identification Number, Social Security Number or Department Identification Number under which the NH business taxes for this entity
will be filed FEIN/SSN:
or DIN:
N L
9
List all individual owners, partners, LLC members, managers, or corporate officers, as applicable:
9(a) PRINT NAME: FIRST, MI, LAST, SUFFIX
SOCIAL SECURITY NUMBER
RESIDENCE ADDRESS - NO PO BOXES
TITLE
TELEPHONE NUMBER
CITY/TOWN, STATE, ZIP CODE + 4
9(b) PRINT NAME: FIRST, MI, LAST, SUFFIX
SOCIAL SECURITY NUMBER
RESIDENCE ADDRESS - NO PO BOXES
TITLE
TELEPHONE NUMBER
CITY/TOWN, STATE, ZIP CODE + 4
9(c) PRINT NAME: FIRST, MI, LAST, SUFFIX
SOCIAL SECURITY NUMBER
RESIDENCE ADDRESS - NO PO BOXES
TITLE
TELEPHONE NUMBER
CITY/TOWN, STATE, ZIP CODE + 4
(IFADDITIONAL SPACE IS NEEDED, ATTACH A SCHEDULE)
PRINT NAME
TITLE
TELEPHONE NUMBER
10
Contact Person
BUSINESS TELEPHONE #
PHYSICAL BUSINESS ADDRESS IN NH (STREET ADDRESS, CITY/TOWN, ZIP CODE)
11
12
PROPOSED OPENING DATE (REQUIRED)
TYPE OF BUSINESS ACTIVITY
13
14
15
Check here if you serve....
Food
Alcoholic Beverages
Number of Seats in Restaurant and/or Lounge
{
{
{
Sleeping Accommodations
Function Rooms
Motor
16
Indicate if you rent.....
Vehicles
Number of Rooms
Seating Capacity
17
Check here
if you are requesting permission to file returns as a seasonal filer. Specify month(s):
PRIOR BUSINESS NAME
PRIOR OWNER(S) NAME
18(a)
18
NH BANKING INSTITUTION
NAME OF ACCOUNT HOLDER
19(a)
19
Complete pages 1 and 2 and submit to the NH Department of Revenue Administration.
I hereby certify that the given information is true and correct and in conformity with applicable State laws. I am aware of my responsibility as
an agent of the State in the collection and remittance of the Meals & Rentals Tax to maintain records as required by RSA 78-A:19 and N.H.
Code of Admin. Rules, Rev. 706.01.
FOR DRA USE ONLY
x
SIGNATURE (IN INK) OF OWNER/OPERATOR FROM LINE 9(a)
DATE
NH DRA
x
MAIL
COLLECTION DIVISION
TO:
PO BOX 454
SIGNATURE (IN INK) OF OWNER/OPERATOR FROM LINE 9(b)
DATE
CONCORD, NH 03302-0454
x
SIGNATURE (IN INK) OF OWNER/OPERATOR FROM LINE 9(c)
DATE
Form CD-3
Rev 04/2013
1
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