Nevada Business Registration And Supplemental Registration Forms With Instructions
ADVERTISEMENT
1
2
3
4NEVADA BUSINESS REGISTRATION
Please see instructions regarding form detail and online registration options.
1
I Am Applying For:
Unemployment Insurance
Sales/Use Tax Permit
Modified Business Tax
Local Business
* SEND A COPY TO EACH AGENCY
License
*(Employment Security Division - ESD)
*(Department of Taxation)
2
New Business
Change in Ownership/ Business Entity
Change in Location
Other
Change in Corporate Officers
Change in Mailing Address
Change in Name
Add Location
3
Business Entity Type:
Sole Proprietor
Association
LLLP
Limited Liability Partnership
Government Entity
Corporation
Limited Partnership
Partnership
Limited Liability Company
Other
3A
If LLC please check Federal
Corporation
Sole Proprietor
Partnership
tax filing type
4
5
Corporate/Entity Name
Corporate/Entity Telephone
Federal Tax Identification Number
(
)
(as shown on State Business License):
6
Corporate/Entity
State of Incorporation or Formation
Street Number, Direction (N, S, E, W ) and Name Suite, Unit or Apt #
City, State, and Zip Code +4
Address:
7
Nevada Name
Business Telephone
Fax
(DBA):
(
)
(
)
8
9
E-mail Address:
Website Address:
Nevada Business Identification #: (11 digits)
NV
10
Mailing Address:
Street Number, Direction (N, S, E, W ) and Name Suite, Unit or Apt #
City, State, and Zip Code +4
11
Location(s) of Nevada
Street Number, Direction (N, S, E, W ) and Name Suite, Unit or Apt #
City, State, and Zip Code +4
Business Operations:
12
Telephone Number:
Location of
Street Number, Direction (N, S, E, W ) and Name Suite, Unit or Apt #
City, State, and Zip Code +4
Business Records:
(
)
13
List All Owners, Partners, Corporate Officers, Managers, Members, etc. (If individual ownership, list only one owner.) Attach Additional Sheets if Needed.
** The Department of Taxation & Employment Security Division are the only agencies to require a SSN.
Last, First, MI :
Residence Address (Street)
**SSN
Date of Birth
Title
Percent Owned
City, State, Zip +4
Residence Telephone
Last, First, MI :
Residence Address (Street)
**SSN
Date of Birth
Title
Percent Owned
City, State, Zip +4
Residence Telephone
Last, First, MI :
Residence Address (Street)
**SSN
Date of Birth
Title
Percent Owned
City, State, Zip +4
Residence Telephone
Responsible Local Contact ( Last, First, MI & Title ):
Residence Address (Street), City, State, Zip +4
**SSN
Residence Telephone
14
Date Business Started in Nevada Date Nevada Location Opened
Date First Worker Hired in Nevada Date of First Nevada Payroll Amount of First Nevada Payroll Number of Employees
15
PLEASE CHECK ALL THAT APPLY TO YOUR BUSINESS
Mining
Domestics
Outside Dining
Water Appropriation
Adult Materials/Activity
Amusement Machines
Registered Agent
Service
Agriculture
Home Occupation
Hazardous Material
Leased or Leasing Employees
Alcohol
Financial Institutions
Tobacco
Manufacturing
Retail Sales—New
Construction/Erection
Leasing (Other than Employees)
Gaming
Mortgage Brokers
Delivery
Transportation
Retail Sales—Used
Tire Sales
Supply/Use Temporary Workers
Health Services
Banker
____
Wholesale
Not for Profit
Live Entertainment
Environmental Discharge
Regulated by Federal/State Permit Number
Other
Medical Marijunana
16
Describe in Detail the Nature of Your Business in Nevada. Include Product Sold, Labor Performed and/or Services Rendered.
16
State the approximate percentage of sales or revenues resulting from each item. Example: Retail sale of major appliances to public 60%; repair 40%.
17
If You Have Acquired A Nevada Business, Changed Ownership/Business Entity, or Have a New Federal Tax Number, Complete This Section:
Date Acquired/Changed:
Acquired/Changed by:
Portion Acquired/Changed:
In Whole
In Part
Purchase
Lease
Other
Name(s) of Previous Owner(s)
Previous Owner(s) Business Name
Address (Street)
City
State
Zip Code +4
Enter Your Previous Nevada Sales/Use Tax Permit Number, if applicable:
Enter Previous Owner(s) ESD Account Number:
18
* Signatures must be that of a responsible party *
I declare under penalty of perjury that the information provided is true, correct and complete to the best of my knowledge and belief and
acknowledge that pursuant to NRS 239.330, it is a category C felony to knowingly offer any false of forged instrument for filing.
*Signature Responsible Party / Original
Print Name And Title
Date
*Signature Responsible Party / Original
Print Name And Title
Date
ORIGINAL SIGNATURES REQUIRED BY AGENCIES – KEEP A COPY FOR YOUR RECORDS
NSPO Rev. 09.14 (O) 4436
APP-01.00
Revised 09-23-14
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Nucs-0736a - Nevada Business Registration Form - Instructions For Unemployment Insurance Registration
Life
Form Llp 2007 - Foreign Limited Liability Partnership Registration Package Of Forms With Instructions - State Of Nevada
Legal
Related Categories
Parent category: Life