Form Cd-3 - New Hampshire Application For Meals & Rentals Tax Operators License Page 2
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4NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
FORM
CD-3
APPLICATION FOR MEALS & RENTALS TAX
OPERATORS LICENSE (RSA 78-A:4)
Page 2
20
Operators having more than one license may request permission to file on a consolidated basis provided all licenses use
CONSOLIDATED
the same Federal Employer Identification Number. Operators must designate one license number to be the master
RETURN
(primary) license number and provide the business name, address and Meals & Rentals License Number of each member
of the group.
20(a)
YES
NO
ARE YOU REQUESTING TO BE A MEMBER OF A CONSOLIDATED MEALS & RENTALS FILING GROUP?
IF YES, SPECIFY MASTER (PRIMARY) LICENSE NUMBER ___________________
20(b) ARE YOU REQUESTING TO BE A MASTER (PRIMARY) FILER FOR A CONSOLIDATED MEALS & RENTALS FILING
GROUP?
YES
NO
IF YES, ATTACH A LIST INDICATING MEMBERS’ MEALS & RENTALS LICENSES, BUSINESS NAMES & ADDRESSES.
21
IS THIS BUSINESS A FRANCHISE?
YES
NO
IF YES, COMPLETE THE FOLLOWING:
FRANCHISE
INFORMATION
FRANCHISE NAME
CONTACT PERSON (LAST, FIRST, MI, SUFFIX)
BUSINESS ADDRESS
CITY/TOWN
STATE
ZIP CODE + 4
MAILING ADDRESS
CITY/TOWN
STATE
ZIP CODE + 4
TELEPHONE / EXTENSION
FAX
E-MAIL ADDRESS
22
THE “PHYSICAL BUSINESS ADDRESS IN NH” AS LISTED ON LINE 12 IS: (CHECK ONE):
OWNED
LEASED/RENTED
BUSINESS
LOCATION
INFORMATION
LANDLORD NAME
LANDLORD TELEPHONE NUMBER
23
23(a) IF CORPORATION, ENTER NAME AND ADDRESS OF NH REGISTERED AGENT:
REGISTRATION,
LICENSING
& PERMIT
HAS ANY INDIVIDUAL LISTED ON LINES 2, 9 OR 10 PREVIOUSLY HELD AN INTEREST IN ANY LIQUOR
INFORMATION
23(b)
YES
NO
LICENSE?
IF YES, DATE ISSUED
LICENSE NUMBER
NAME OF LICENSEE
HAS ANY INDIVIDUAL LISTED ON LINES 2, 9 OR 10 EVER BEEN ISSUED A MEALS & RENTALS LICENSE?
23(c)
YES
NO
IF YES, DATE ISSUED
LICENSE NUMBER
NAME OF LICENSEE
DOES THE BUSINESS LISTED ON LINES 1 AND 2 HOLD ANY OTHER LOCAL AND/OR STATE
23(d)
YES
NO
LICENSES OR PERMITS (SEE INSTRUCTIONS)?
IF YES, LIST (ATTACH ADDITIONAL SHEETS IF NECESSARY):
TYPE OF LICENSE
DATE ISSUED
LICENSE NUMBER
NAME OF LICENSEE
Form CD-3
2
Rev 04/2013
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