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012413 APP-01 00 Nevada Business Registration - APP-01 01 Supplemental Combined With Instructions 12-14-12 - APP-01 00 Nevada Business Registration - APP-01 01 Supplemental Combined With Instructions 11-14-12 A

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NEVADA BUSINESS REGISTRATION
Please see instructions regarding form detail and online registration options.
1
I Am Applying For:
* SEND A COPY TO EACH AGENCY
Unemployment Insurance
*(Employment Security Division - ESD)
Sales/Use Tax Permit Modified Business Tax
*(Department of Taxation)
Local Business
License
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:
If LLC please check Federal
tax filing type
Sole Proprietor Association LLLP Limited Liability Partnership Government Entity
3A
Corporation
Corporation
Limited Partnership
Sole Proprietor
Partnership
Partnership
Limited Liability Company Other
4
Corporate/Entity Name
(as shown on State Business License):
Corporate/Entity Telephone
( )
5
Federal Tax Identification Number
6
Corporate/Entity
Address:
Street Number, Direction (N, S, E, W ) and Name Suite, Unit or Apt # City, State, and Zip Code +4
State of Incorporation or Formation
7
Nevada Name
(DBA):
Business Telephone
( )
Fax
( )
8
E-mail Address: Website Address:
9
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
Business Operations:
Street Number, Direction (N, S, E, W ) and Name Suite, Unit or Apt #
City, State, and Zip Code +4
12
Location of
Business Records:
Street Number, Direction (
N, S, E, W ) and Name Suite, Unit or Apt #
City, State, and Zip Code +4
Telephone Number:
( )
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 Addr
ess (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 Teleph
one
Responsible Local Contact ( Last, First, MI & Title ):
Residence Address (Street), City, State, Zip +4
**SSN
Residence Telephone
14
Date Busines
s 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 Em
ployees
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
____
17
If You Have Acquired A Nevada Business, Changed Ownership/Business Entity, or Have a New Federal Tax Number, Complete This Se
c
tion:
Date Acquired/Changed: Acquired/Changed by:
Purchase
Lease
Other
Portion Acquired/Changed:
In Whole
In Part
Name(s) of Previous Owner(s) Previous Owner(s) Business Name
Address (Street)
City State
Zip Code +4
Enter Your Previous Nevada
S
ales/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
APP-01.00
Revised 09-23-14
16 Describe 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%.
Medical Marijunana
NSPO Rev. 09.14 (O) 4436
16
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 haven’t 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 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 http://IRS.gov/businesses. 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: https://www.nevadatax.nv.gov – Website: http://www.tax.nv.gov
Call Center Toll Free Taxation Help Desk …………..…………………………………………………….. (866) 962-3707
Las Vegas….. 555 E Washington Avenue • Suite 1300 • Las Vegas Nevada • 89101………………....... (702) 486-2300
Reno………… 4600 Kietzke Lane • Building L, Suite 235 • Reno, NV • 89502…………………………….. (775) 687-9999
Carson City…. 1550 College Parkway • Suite 115 • Carson City, NV • 89706…………………………...... (775) 684-2000
Nevada Employment Security Division (ESD): Online Registration: https://uitax.nvdetr.org – Website: www.nvdetr.org
Las Vegas ………………………………………………………………………………………………………….. (702) 486-0250
Reno ……………………………………………………………………………………………………………….. (775) 823-6680
Statewide (Mailing)….. 500 E Third Street • Carson City, NV • 89713-0030 .. ………………………….. (775) 684-6300
Nevada Department of Wildlife: (Industrial Artificial Pond Permit) – Website: www.ndow.org.......................... (775) 688-1500
Nevada Secretary of State: ………………………………………………………………………..………………………… (775) 684-5708
For more information regarding local and state business licensing please visit Nevada’s online Business Portal at
https://www.nvsilverflume.gov.
APP-01.01
Revised 09-23-14
NSPO Rev. 09.14 (O) 4436
Sales/Use Tax
Use Tax
NEVADA DEPARTMENT OF TAXATION
SUPPLEMENTAL REGISTRATION
Please print clearly — Use black or blue ink only
Please mark applicable type(s) (See Instructions)
APP-01.01
Revised 09-23-14
For Department Use Only
TID:
Dept. of Taxation Representative accepting application:
Sales/Use Permit
Consumer Use Tax Permit
Certificate of Authority
Live Entertainment Tax
1.
DBA (as shown on the Nevada Business Registration Form):
2.
Business telephone number:
3.
List STATE of incorporation or formation if applicable:
4.
FEES AND SECURITY DEPOSIT
5.
Estimated total monthly receipts:
6.
Estimated total Nevada monthly TAXABLE receipts:
7.
Reporting cycle (check choice of reporting)
Sales Tax Accounts with over $10,000 a month in TAXABLE sales must report monthly.
Monthly Quarterly Annual
8.
Cash
Surety #
9.
Sales Tax Fee (See instructions):
10.
Total Nevada Business Locations:
11.
OTHER INFORMATION
Name of spouse/relative Address of spouse/relative
Phone number of spouse/relative
Name of other contact Address of other contact Phone number of other contact
Accountant/bookkeeper Address of accountant/bookkeeper Phone number of accountant/bookkeeper
Other employment (If applicable):
Company name:
Company name:
Name of bank/financial institution
–
location / account number:
Business account:
Personal account:
FOR DEPARTMENT USE ONLY
ST/UT No.: MBT No.:
Combine Accts: Yes No Previous Acct: Previous Acct Cancelled: Yes
No
Comments:
Cash Check ABA #: Bank: Branch:
**For an introduction to the Department and general information, see our Taxpayer Information Packet Online at www.tax.nv.gov **
Security (See Instructions)
Live Enterainment Tax Occupancy 200-7,499 7,500 or More
NSPO Rev. 09.14 (O) 4436
SUPPLEMENTAL APPLICATION
■
$ 0
15.00
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 State’s Office to do
business in Nevada
5.
Estimated Total Monthly Receipts – this is the total of all gross receipts including wholesale sales, services necessary to complete the
sale, 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. This is your estimated average monthly tax liability. 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 include other authorized contacts.
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.
THIS FORM MUST BE SUBMITTED WITH YOUR
NEVADA BUSINESS REGISTRATION FORM
APP-01.01
Revised 09-23-14
NSPO Rev. 09.14 (O) 4436
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