FORM
2012
Comptroller of Maryland
CRA
Combined Registration Application
Page I
12CRA0049
SECTION A: All applicants must complete this section.
1 a. 9 digit Federal Employer Identification Number (See instructions)
b. Social Security number of owner, officer or agent responsible for taxes
(Required by law)
(if different from Legal name of dealer, employer, corporation or owner)
2. Legal name of dealer, employer, corporation or owner
3. Trade name
4. Street Address of physical business location (P.O. box not acceptable)
(9 digits if known)
City
County
State
ZIP code
Telephone number
Fax number
E-mail address
5. Mailing address (P.O. box acceptable)
(9 digits if known)
City
State
ZIP code
6. Reason for applying:
New business
Additional location(s)
Merger
Purchased going business
Re-activate/Re-open
(check all that apply)
Reorganization
Change of entity
Remit use tax on purchases
Other (describe) _________________________
7. Previous owner’s name: First Name or Corporation Name
Last Name
Title
Telephone number
Street address (P.O. box acceptable)
(9 digits if known)
City
State
ZIP code
(must check appropriate box(es))
(Check one box)
8.
Type of registration:
Maryland Number if registered:
9.
Type of ownership:
a.
Sales and use tax
_________________________
a.
Sole proprietorship
f.
Non-Maryland corporation
b.
Sales and use tax exemption
b.
Partnership
g.
Governmental
for nonprofit organizations
_________________________
Nonprofit organization
h.
c.
Fiduciary
c.
Tire recycling fee
_________________________
d.
Maryland corporation
i.
Business trust
d.
Admissions & amusement tax
_________________________
e.
Limited liability company
e.
Employer withholding tax
_________________________
10. Date first sales made
in Maryland: (mm dd yyyy)
f.
Unemployment insurance
_________________________
___ ___
___ ___
___ ___ ___ ___
11. Date first wages paid
g.
Alcohol tax
_________________________
in Maryland subject
to withholding: (mm dd yyyy)
h.
Tobacco tax
_________________________
___ ___
___ ___
___ ___ ___ ___
12. If you currently file a
i.
Motor fuel tax
_________________________
consolidated sales and
use tax return, enter the
j.
Transient vendor license
_________________________
8 digit CR number of
your account:
____ ____ ____ ____ ____ ____ ____ ___
13. If you have employees enter the number of your workers’ compensation insurance policy or binder:
14. (a) Have you paid or do you anticipate paying wages to individuals, including corporate officers, for services performed in Maryland?
Yes
No
(b) If yes, enter date wages first paid (mm dd yyyy)
____ ____
____ ____
____ ____ ____ ____
15. Number of employees:
16. Estimated gross wages paid in first quarter of operation:
17. Do you need a sales and use tax account only to remit taxes on untaxed purchases?
Yes
No
18. Describe for profit or nonprofit business activity that generates revenue. Specify the product manufactured and/or sold, or the type of service performed.
COM/RAD - 093
12-49