ࡱ> ~{|} bjbjWW 4==9/9/++/+++++22.+++4++++9+++++++++6 V: NEVADA BUSINESS REGISTRATION Please see instructions regarding form detail and online registration options. 1I Am Applying For: * SEND A COPY TO EACH AGENCY  FORMCHECKBOX  Unemployment Insurance *(Employment Security Division - ESD)  FORMCHECKBOX  Sales/Use Tax Permit  FORMCHECKBOX  Modified Business Tax *(Department of Taxation)  FORMCHECKBOX  Local Business License  2 FORMCHECKBOX  New Business  FORMCHECKBOX  Change in Ownership/ Business Entity  FORMCHECKBOX  Change in Location  FORMCHECKBOX  Other  FORMCHECKBOX  Change in Corporate Officers FORMCHECKBOX  Change in Mailing Address FORMTEXT        FORMCHECKBOX  Change in Name FORMCHECKBOX  Add Location 3Business Entity Type: If LLC please check Federal tax filing type  FORMCHECKBOX  Government Entity.  FORMCHECKBOX  Sole Proprietor  FORMCHECKBOX  Association  FORMCHECKBOX  LLLP   FORMCHECKBOX  Limited Liability Partnership   FORMCHECKBOX  Government Entity  3A FORMCHECKBOX  Corporation  FORMCHECKBOX  Corporation  FORMCHECKBOX  Limited Partnership  FORMCHECKBOX  Sole Proprietor  FORMCHECKBOX  Partnership  FORMCHECKBOX  Partnership  FORMCHECKBOX  Limited Liability Company  FORMCHECKBOX  Other  FORMTEXT        4Corporate/Entity Name (as shown on State Business License):  FORMTEXT      Corporate/Entity Telephone ( FORMTEXT     )  FORMTEXT       5Federal Tax Identification Number  FORMTEXT       6Corporate/Entity Address: Street Number, Direction (N, S, E, W ) and Name Suite, Unit or Apt # City, State, and Zip Code +4  FORMTEXT      State of Incorporation or Formation  FORMTEXT       7Nevada Name (DBA):  FORMTEXT      Business Telephone ( FORMTEXT     )  FORMTEXT      Fax ( FORMTEXT     )  FORMTEXT       8E-mail Address:  FORMTEXT      Website Address:  FORMTEXT        9Nevada Business Identification #: (11 digits) NV FORMTEXT       10Mailing Address:  Street Number, Direction (N, S, E, W ) and Name Suite, Unit or Apt # City, State, and Zip Code +4  FORMTEXT        11Location(s) of Nevada Business Operations: Street Number, Direction (N, S, E, W ) and Name Suite, Unit or Apt # City, State, and Zip Code +4  FORMTEXT        12Location of Business Records: Street Number, Direction (N, S, E, W ) and Name Suite, Unit or Apt # City, State, and Zip Code +4  FORMTEXT       Telephone Number: ( FORMTEXT    )  FORMTEXT       13List 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 :  FORMTEXT       Residence Address (Street)  FORMTEXT      **SSN  FORMTEXT       Date of Birth  FORMTEXT       Title  FORMTEXT       Percent Owned  FORMTEXT       City, State, Zip +4  FORMTEXT       Residence Telephone  FORMTEXT       Last, First, MI :  FORMTEXT       Residence Address (Street)  FORMTEXT      **SSN  FORMTEXT       Date of Birth  FORMTEXT       Title  FORMTEXT       Percent Owned  FORMTEXT       City, State, Zip +4  FORMTEXT       Residence Telephone  FORMTEXT       Last, First, MI :  FORMTEXT       Residence Address (Street)  FORMTEXT      **SSN  FORMTEXT       Date of Birth  FORMTEXT       Title  FORMTEXT       Percent Owned  FORMTEXT       City, State, Zip +4  FORMTEXT       Residence Telephone  FORMTEXT       Responsible Local Contact ( Last, First, MI & Title ):  FORMTEXT       Residence Address (Street), City, State, Zip +4  FORMTEXT       **SSN  FORMTEXT       Residence Telephone  FORMTEXT       14Date Business Started in Nevada  FORMTEXT      Date Nevada Location Opened  FORMTEXT      Date First Worker Hired in Nevada  FORMTEXT      Date of First Nevada Payroll  FORMTEXT      Amount of First Nevada Payroll  FORMTEXT      Number of Employees  FORMTEXT       15 PLEASE CHECK ALL THAT APPLY TO YOUR BUSINESS FORMCHECKBOX  Mining  FORMCHECKBOX  Domestics  FORMCHECKBOX  Outside Dining  FORMCHECKBOX  Water Appropriation  FORMCHECKBOX  Adult Materials/Activity  FORMCHECKBOX  Amusement Machines  FORMCHECKBOX  Registered Agent  FORMCHECKBOX  Service  FORMCHECKBOX  Agriculture  FORMCHECKBOX  Home Occupation  FORMCHECKBOX  Hazardous Material  FORMCHECKBOX  Leased or Leasing Employees  FORMCHECKBOX  Alcohol  FORMCHECKBOX  Financial Institutions  FORMCHECKBOX  Tobacco  FORMCHECKBOX  Manufacturing  FORMCHECKBOX  Retail SalesNew  FORMCHECKBOX  Construction/Erection  FORMCHECKBOX  Leasing (Other than Employees)  FORMCHECKBOX  Gaming  FORMCHECKBOX  Mortgage Brokers  FORMCHECKBOX  Delivery  FORMCHECKBOX  Transportation  FORMCHECKBOX  Retail SalesUsed  FORMCHECKBOX  Tire Sales  FORMCHECKBOX  Supply/Use Temporary Workers  FORMCHECKBOX  Health Services  FORMCHECKBOX  Banker  FORMCHECKBOX  Wholesale  FORMCHECKBOX  Not for Profit  FORMCHECKBOX  Live Entertainment  FORMCHECKBOX  Environmental Discharge  FORMCHECKBOX  Regulated by Federal/State Permit Number  FORMTEXT        FORMCHECKBOX Other  FORMTEXT      ____ 16Describe in Detail the Nature of Your Business in Nevada. Include Product Sold, Labor Performed and/or Services Rendered. State the approximate percentage of sales or revenues resulting from each item. Example: Retail sale of major appliances to public 60%; repair 40%.  FORMTEXT        17If You Have Acquired A Nevada Business, Changed Ownership/Business Entity, or Have a New Federal Tax Number, Complete This Section:Date Acquired/Changed: FORMTEXT      Acquired/Changed by:   FORMCHECKBOX  Purchase  FORMCHECKBOX  Lease  FORMCHECKBOX  Other  FORMTEXT       Portion Acquired/Changed:  FORMCHECKBOX  In Whole  FORMCHECKBOX  In PartName(s) of Previous Owner(s)  FORMTEXT      Previous Owner(s) Business Name  FORMTEXT      Address (Street) City State Zip Code +4  FORMTEXT       Enter Your Previous Nevada Sales/Use Tax Permit Number, if applicable:  FORMTEXT      Enter Previous Owner(s) ESD Account Number:  FORMTEXT       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  FILENAME \p APP-01.00 Revised 11-01-12 NEVADA BUSINESS REGISTRATION FORM INSTRUCTIONS Important details are included to help you provide the necessary information. It is important to respond to all items. Any omission could cause a delay in processing your registration. WHO ACCEPTS THIS FORM? The Nevada Department of Taxation and the Nevada Employment Security Division (ESD). Some local governments may accept this form. WHAT OTHER INFORMATION MUST I PROVIDE? When applying with the Department of Taxation: All businesses must complete a Supplemental Application (APP-01.01) to determine correct fees. When applying with the Employment Security Division: If you employ agricultural or domestic workers or are a non-profit agency, you must complete a Supplemental Registration with ESD. If you havent yet received or applied for a Nevada State Business License, please contact the Nevada Secretary of State at (775) 684-5708 or complete your registration online at  HYPERLINK "https://www.nvsilverflume.gov" https://www.nvsilverflume.gov.LINE-BY-LINE INSTRUCTIONS FOR COMPLETING THE NEVADA BUSINESS REGISTRATION - PLEASE COMPLETE IN ENGLISH. 1. I Am Applying For: Check the boxes that apply. You are required to submit a copy to each agency that is applicable to your business. Keep a copy for your records. 2. Check All Box(es) That Apply. 3. Business Entity Type: Indicate entity type as filed with the Secretary of State. 3A. If LLC: Indicate type of entity as filed with the IRS. 4. Corporate/Entity Name: Enter the name as registered with the Secretary of State for the State Business License. Include a telephone number. 5. Federal Tax Identification Number: Enter your Federal Tax Identification Number (FEIN). For information regarding a FEIN, contact the Internal Revenue Service at 1-800-829-4933 or go to  HYPERLINK "http://IRS.gov/business" http://IRS.gov/business. If you have applied for your number and have not received it, write PENDING. If your FEIN changes, you must complete a new Nevada Business Registration. 6. Corporate/Entity Address: Enter the complete address of the corporation and the state of incorporation. 7. Nevada Name (DBA): Enter the name as it will be known to the public. Include a business telephone and fax number. 8. E-mail Address / Website Address: Enter Email and Website Address information. 9. Nevada Business ID Number: Enter the number as shown on your State Business License or exemption issued by the Secretary of State. 10. Mailing Address: This address will be used to mail any licenses, reports, tax returns, and correspondence. 11. Location(s) of Nevada Business Operations: Enter the physical location of the business including suite numbers, apartment numbers, and street direction (N, S, E, and W). If there are additional locations in Nevada, please attach a list of all locations. You may not use a PO Box. 12. Location of Business Records: Enter the physical address where business records are maintained during normal working hours. Include the telephone number of this location, if different from the business telephone number. 13. List All Owners, Partners, Corporate Officers, Managers, Members, etc.: Include the full name, home address (street, city, state, and zip code), Social Security Number, date of birth, title, percentage of business owned, and telephone number. If the business is incorporated, list all corporate officers. If the business is a partnership, list all partners. If the business is comprised of two corporations or other entities, list the officers/members/partners, etc. for each entity. Attach additional sheets if needed. 14. Dates and Amounts Regarding Your Nevada Business: Enter the date the business started or will start Nevada operations. If adding a location enter the date your additional location will begin Nevada operations. Enter the date the first worker was hired in Nevada. Enter the date and amount of the first Nevada payroll. If this is a new business, enter the estimated number of employees you will have. If the business is currently operating, list the number of employees on the payroll. 15. Please Check All That Apply to Your Business: If you check the box marked Regulated by Federal/State Permit Number, attach a list that identifies the issuing entity and permit number. 16. Nature of Your Business: Describe your business activities, goods, products, or services in Nevada. State the approximate percentage of sales or revenues resulting from each item. Example: Retail sale of major appliances to public 60%; repair 40%. 17. Acquired, Changed, or Have a New Federal Tax Number: On the first line, enter the date the business was acquired; check the boxes that apply to how the business was acquired; and the portion of the business you acquired. On the second line, list the name of the previous owner and the business name of the previous owner. On the third line, indicate the physical address of the business you acquired. On the fourth line, list your previous Nevada Sales/Use Tax Permit Number and the Employment Security Division (ESD) Account Number of the previous owner. If there is more than one previous owner, attach an additional sheet. 18. Signature Required: Legal signatures include: sole proprietor-owner, corporate officer, managing member and partners. Toll Free (In State) for All State of Nevada...800-992-0900  Nevada Department of Taxation: Online Registration:  HYPERLINK "https://www.nevadatax.nv.gov" https://www.nevadatax.nv.gov Website: http://www.tax.state.nv.usCall CenterToll Free Taxation Help Desk ....(866) 962-3707Las Vegas..555 E Washington Avenue Suite 1300 Las Vegas Nevada 89101.......(702) 486-2300Reno4600 Kietzke Lane Building L, Suite 235 Reno, NV 89502..(775) 687-9999Carson City.1550 College Parkway Suite 115 Carson City, NV 89706......(775) 684-2000 Nevada Employment Security Division (ESD): Online Registration: HYPERLINK "https://uitax.nvdetr.org/"https://uitax.nvdetr.org Website: www.nvdetr.orgLas Vegas..(702) 486-0250Reno..(775) 823-6680Statewide (Mailing)..500 E Third Street Carson City, NV 89713-0030.. ..(775) 684-6300Nevada Department of Wildlife: (Industrial Artificial Pond Permit) Website: www.ndow.org..........................(775) 688-1500Nevada Secretary of State:..(775) 684-5708For more information regarding local and state business licensing please visit Nevadas online Business Portal at  HYPERLINK "https://www.nvsilverflume.gov" https://www.nvsilverflume.gov.  For Department Use OnlyTID:  FORMTEXT      Dept. of Taxation Representative accepting application:  FORMTEXT       NEVADA DEPARTMENT OF TAXATION SUPPLEMENTAL REGISTRATION Please print clearly  Use black or blue ink only Please mark applicable type(s) (See Instructions)  FORMCHECKBOX  Sales/Use Permit FORMCHECKBOX  Consumer Use Tax Permit  FORMCHECKBOX  Certificate of Authority FORMCHECKBOX  Live Entertainment Tax 1.DBA (as shown on the Nevada Business Registration Form):  FORMTEXT       2.Business telephone number:  FORMTEXT      3.List STATE of incorporation or formation if applicable:  FORMTEXT       4.FEES AND SECURITY DEPOSIT 5.Estimated total monthly receipts:  FORMTEXT      6.Estimated total Nevada monthly TAXABLE receipts:  FORMTEXT       7.Reporting cycle (check choice of reporting) Sales Tax Accounts with over $10,000 a month in TAXABLE sales must report monthly. Sales/Use Tax Use Tax Live Entertainment Tax Occupancy  FORMCHECKBOX  200 to 7,499  FORMCHECKBOX  7,500 or More Reporting cycle-(check choice of reporting) Sales Tax Accounts with over $10,000 a month Monthly Quarterly Annual  FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX  8. 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 FORMTEXT       MBT No.:  FORMTEXT       Combine Accts:  FORMCHECKBOX  Yes  FORMCHECKBOX  No Previous Acct:  FORMTEXT       Previous Acct Cancelled:  FORMCHECKBOX  Yes  FORMCHECKBOX  No Comments:  FORMTEXT        FORMCHECKBOX  Cash  FORMCHECKBOX  Check ABA #:  FORMTEXT       Bank:  FORMTEXT       Branch:  FORMTEXT      **For an introduction to the Department and general information, see our Taxpayer Information Packet Online at  HYPERLINK "http://tax.nv.gov/" http://tax.nv.gov/**  APP-01.01 SUPPLMENTAL APPLICATION Revised 11-01-12 SUPPLEMENTAL REGISTRATION INSTRUCTIONS Sales/Use Tax A business which sells tangible personal property at retail or wholesale, and has a physical location in Nevada or enters Nevada to conduct business Consumer Use Tax This permit allows a Nevada business, not required to hold a Nevada Sales/Use Tax permit, to pay use tax directly to the State on tangible personal property purchased from a vendor not registered to collect Nevada sales tax. Example: Contractors who do not make sales and only purchase building materials for their own use from out of state. All businesses required to register for the State Business License that purchase tangible personal property for storage, use or other consumption in Nevada must also register for use tax. Registering for use tax does not require payment of a fee, nor does it require security. Certificate of Authority This permit is available to out-of-state businesses having no jurisdiction or nexus in Nevada. The permit allows an out-of-state business, who is not required to hold a Nevada Sales/Use Tax permit, to voluntarily register in order to collect and remit use tax as a convenience for its Nevada customers. This permit does not require payment of a fee, nor does it require security. Live Entertainment Tax (LET) Monthly tax is based on admission charges, merchandise, food and refreshment sales for non-gaming facilities providing live entertainment with maximum occupancy of 200 to 7,499. Monthly tax is based on admission charges only for non-gaming facilities providing live entertainment with occupancy of 7,500 or more. If the maximum occupancy is under 200, no tax liability exists. Maximum occupancy that meets or exceeds 200 must register for the Live Entertainment Tax. Maximum occupancy means the maximum occupancy of the facility as determined by the State Fire Marshal or local governmental agency. 1. DBA - Name doing business as 2. Business Telephone Number please include area code 3. State of Incorporation or Formation foreign corporations must be registered with the Nevada Secretary of States Office to do business in Nevada 5. Estimated Total Monthly Receipts this is the total of all gross receipts including wholesale sales, labor, exempt sales, etc 6. Estimated total Nevada monthly TAXABLE receipts this is the total of taxable sales only of tangible personal property. Do not include wholesale sales, labor, exempt sales, etc 7. Reporting Cycle Please indicate filing frequency desired. Sales or purchases exceeding $10,000 require monthly reporting. Options may not apply to certain tax types. 8. Security Check off type of security deposited. A Sales/Use Tax permit will not be issued until applicable security is submitted. In order to determine the security requirement, compute your average monthly taxable sales. Multiply taxable Nevada sales by the highest tax rate in Nevada, which is 8.10% as of 07/01/09. 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Security is required equal to three times your monthly tax liability for monthly reporting or six times monthly tax liability for quarterly reporting. A security deposit will not be required if the amount calculated does not exceed $1,000. There is no maximum security. After three full years of perfect reporting, you may apply for a waiver of the security requirement. 9. Sales Tax Fee A $15.00 permit fee for EACH in-state business location is required. If the business does not have a physical location in Nevada, it must still pay a minimum fee of $15.00. Total number of locations (#10) should be multiplied by the Sales Tax fee (example: 3 Nevada Business Locations times (x) $15.00 fee = $45.00. 10. Total Nevada Business Locations number of physical locations in Nevada 11. Other Information please complete all that apply Note: Modified Business Tax (MBT) General Business (MBTGB) / Modified Business Tax - Financial Institutions (MBTFI) is a Quarterly tax based on gross wages reported to the Employment Security Division. There is an allowable deduction for qualified health insurance or plan. Exceptions include non-profit 501c organizations, Indian tribes, political subdivisions per NRS 612.055, and any person who does not supply a product/service but consumes a service. Contact the Employment Security Division to determine if you are required to register with that agency. 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