Fillable Ar1r AR-1R Combined Business Tax Registration Form (State of Arkansas)

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Ar1r AR-1R Combined Business Tax Registration Form (State of Arkansas)

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The Ar1r AR-1R Combined Business Tax Registration Form (State of Arkansas) form is 7 pages long and contains:

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AR-1R
ARKANSAS DEPARTMENT OF FINANCE AND ADMINISTRATION
Combined Business Tax Registration Form
PO Box 8123 Little Rock, AR 72203-8123
Read instructions carefully before completing this form. For assistance call (501) 682-1895. Register a new business online using ATAP at www.atap.arkansas.gov
REASON FOR SUBMITTING THIS FORM
Check One:
SECTION A - TAX TYPES
Type of Registration: (Check all that apply)
New Business -
Never Registered
Add Additional
Location
Add Additional
Tax Type
ATAP
Third Party Access
Ownership
Change
Sales and Use
Withholding Wage
Withholding Pension
Withholding Pass Through
Corporation Income
Dyed Diesel
Brine Severance
Natural Gas Severance
Oil Severance
Timber Severance
Liquor
Wine
Cigarette
Cigarette Papers
Other Tobacco Products
1.
Bingo/Raffle
Merchandise Vending
Telecommunications
Construction
Wheat
Soybean
Rice
Corn/Grain Sorghum
Catfish Feed
Amusement
SECTION B - OWNER INFORMATION
Ownership Type: (Check only one)
Federal Identification Number (FEIN): (Required)
Non-Profit Fiduciary / Trust Government LLC Partnership Corporation
-
OR
Social Security Number: (Required)
Sole Proprietor
Owner's Name: (Enter full legal name of Business. If you selected Sole Proprietor owner type, enter first name, middle name, and last name.)
DBA: (Enter full Doing Business As Name, if applicable.)
Primary Business Activity: (Enter the NAICS code that best matches your business (see instructions) and describe your business activity.
a) NAICS
b) Brief Description
Physical Location Address
a) Street (Not PO Box) b) Unit c) Phone Number: (Include Area Code)
d) City
e) County
f) State g) Zip Code
Mailing Address
a) In Care Of
b) Street Address or PO Box
c) City
d) State e) Zip Code
- -
2.
3.
4.
5.
6.
7.
Partnership Income
Motor Fuel
Other Severance
Beer
Soft Drink
Beef
Bovine/Pseudorabies Beauty Pageant
Waste Tire
Revised 07/24/2015 Page 1 of 7
Print Form
Clear Form
SECTION C - RESPONSIBLE PARTY
. Complete this line for each responsible party who is an owner, partner, member, corporation officer or trustee.
. Attach additional pages if needed.
. In the case of limited partnerships, complete this section for each general partner.
. See instructions for additional information.
8.
a) Name of Responsible Party b) SSN or FEIN
c) Title d) Effective Date e) Phone Number (Include Area Code) f) E-Mail Address
g) Street Address or PO Box
h) City, State, Zip Code
9.
a) Name of Responsible Party b) SSN or FEIN
c) Title d) Effective Date e) Phone Number (Include Area Code) f) E-Mail Address
g) Street Address or PO Box h) City, State, Zip Code
10.
a) Name of Responsible Party b) SSN or FEIN
c) Title d) Effective Date e) Phone Number (Include Area Code) f) E-Mail Address
g) Street Address or PO Box h) City, Sate, Zip Code
11.
a) Name of Responsible Party
b) SSN or FEIN
c) Title
d) Effective Date e) Phone Number (Include Area Code) f) E-Mail Address
g) Street Address or PO Box h) City, State, Zip Code
Contact Information
12.
a) Name b) Title c) Contact Phone Number: (including area code)
d) E-Mail Address e) Fax Number
SECTION D - SIGNATURE
SECTION C - RESPONSIBLE PARTY
SECTION D - SIGNATURE
13.
Important - Read Before Signing.
This registration form must be signed by a responsible party who is authorized to sign on behalf of the organization. The Proprietor must sign for sole
proprietorship.
I declare under the penalties of perjury that the information provided (including any accompanying statements) has been examined by me, and to the
best of my knowledge and belief, is true, correct, and complete.
a) Signature b) Date
c) Printed Name d) Title
Page 2 of 7Revised 07/24/2015
SECTION E - SALES AND USE
14.
15.
a) Physical Location Address (if different from Section B) b) City c) County d) State e) Zip Code
16. a) Are you renting/leasing the property? Yes No b) If yes, provide a copy of the Lease Agreement. (Required)
17.
a) Did you purchase the inventory, fixtures, or equipment of an established business? Yes No
18.
b) If Yes, attach a copy of the Bill of Sale and enter name of previous owner: c) Former Business Account ID:
a) What is the dollar value of your inventory? b) Equipment and Fixtures?
19.
Beer Wine Liquor Mixed Drink Private Club On-Premises Consumption Off-Premises Consumption
20. a) Do you operate more than one business in Arkansas? Yes No
b) If yes, attach a separate schedule. Include all location's names and addresses.
21. a) Do you operate a business at your resident address? Yes No
b) If yes, attach a copy of your city business license or a statement that a license is not required.
Do you perform any type of service (including repair) within the State of Arkansas? If yes, describe exactly the service performed.
22.
23.
Special Additional Taxes: Check all that apply to your type of business. See instructions for detailed information on each tax.
Short Term Rental Vehicle Tax Tourism Tax Wholesale Vending Tax
Short Term Rental Tax Aviation Tax Residential Moving Tax
Sell Aviation Fuel
24.
a) Important Information: A $50.00 non-refundable application fee is required of all Arkansas vendors on a retail or wholesale basis. Out-of-state vendors that lease
property into Arkansas or perform taxable services in Arkansas are required to pay the $50 non-refundable application fee.
(If you answer yes to 1, 2, or 3 below, the fee is required. )
1. Do you have an Arkansas location or have inventory in Arkansas AND make sales on a retail basis?
Yes No
2. Do you perform a taxable service in Arkansas? Yes No
3. Do you lease or rent tangible property in Arkansas?
Yes No
4. Will the business make purchases of services or tangible personal property (e.g. equipment, furnishings, materials, or supplies)
from vendors located outside the state of Arkansas?
Yes No
b) Arkansas Code Annotated 26-52-207 states that the tax liability of the former owner transfers to the new owner when the business is sold. No permit will be
issued to the new owner until all tax liability is paid.
c) The former owner of a business must surrender the permit, and report and pay all taxes due by the business through the transfer date. A lien will attach to the
stock and fixtures to secure the State of Arkansas for delinquent taxes and is enforceable against the purchaser.
d) Arkansas law requires each location collecting Sales or Use Tax to register and pay the $50.00 non-refundable application fee.
d) Description of Business Activityc) NAICS
i) Zip Codeh) Stateg) Cityf) Mailing Address (if different from Section B)
SECTION F - WITHHOLDING WAGE
d) Zip Codec) Stateb) City
b) FEIN: c) DBA (if applicable)a) Date Arkansas Withholding required
a) Mailing Address (if different from Section B)
26.
25.
SECTION G - WITHHOLDING PASS THROUGH
28.
c) DBA (if applicable)b) FEIN:a) Date Arkansas Withholding required27.
SECTION H - WITHHOLDING PENSION
29.
30.
b) FEIN: c) DBA (if applicable)a) Date Arkansas Withholding required
Does this business sell or serve alcoholic beverages? If so, please check each that applies and enter the ABC permit number:
d) Zip Codec) Stateb) Citya) Mailing Address (if different from Section B)
d) Zip Codec) Stateb) Citya) Mailing Address (if different from Section B)
b) DBA (if applicable)a) Date Activity Begins in AR
Revised 07/24/2015 Page 3 of 7
SECTION I - CORPORATE INCOME (INCLUDING SUB S ELECTION)
31.
32.
For Sub S Election please complete and attach form AR1103.
SECTION J - PARTNERSHIP INCOME
Yes NoAre you acquiring an existing business that held a Motor Fuel Tax License?41.
b) License Number Yes Noa) Have you previously held a Motor Fuel Tax License in Arkansas?40.
Yes NoDo you transport petroleum in any device having a carrying capacity exceeding 9,500 gallons? 39.
Pipeline Barge Rail Truck
38.
If importing or exporting Fuel, what means of Transport will you utilize?
Natural Gas Liquefied Gas Distillate Special Fuels Gasoline
37.
Please check the Fuel Type you plan to import or purchase for resale or distribution in Arkansas.
36.
c) DBA (if applicable)
b) DUNS Number:a) Date to start purchasing or importing Fuel into Arkansas:
35.
SECTION K - MOTOR FUEL
33.
34.
a) Company Name
Blend Gasoline or Diesel Fuel with Alcohol or Ethanol, other Petroleum Products, Agricultural or Waste of such Products?
Export Fuel from Arkansas? Take Ownership of Fuel at an Arkansas Terminal? Sell Fuel to Non-Licensed Reseller or Consumer?
Sell Fuel to other Arkansas Licensed Distributors? Have any Transactions in Dyed Petroleum Products? Import Fuel into Arkansas?
If you are granted a License, do you expect to:
45.
b) Diesela) GasolineEstimate the number of gallons to be reported in the State of Arkansas each month.44.
No YesDo you have Bulk Storage Facilities in Arkansas?43.
b) Account Number42.
SECTION L - DYED DIESEL
47.
46.
SECTION M - BRINE SEVERANCE
50.
PurchaserProducerPlease check the applicable classification.49.
48.
SECTION N - NATURAL GAS SEVERANCE
52.
d) AR Oil/Gas Commission Operator Number (if applicable):PurchaserProducerc) Please check the applicable classification.
51.
d) Zip Codec) Stateb) Citya) Mailing Address (if different from Section B)
d) Zip Codec) Stateb) Citya) Mailing Address (if different from Section B)
d) Zip Codec) Stateb) Citya) Mailing Address (if different from Section B)
d) Zip Codec) Stateb) Citya) Mailing Address (if different from Section B)
d) Zip Codec) Stateb) Citya) Mailing Address (if different from Section B)
d) Zip Codec) Stateb) Citya) Mailing Address (if different from Section B)
b) DBA (if applicable)a) Date Activity Begins in AR
b) DBA (if applicable)a) Date Activity Begins in AR
b) DBA (if applicable)a) Date Activity Begins in AR
b) DBA (if applicable)a) Date Activity Begins in AR
b) DBA (if applicable)a) Date Activity Begins in AR
Page 4 of 7Revised 07/24/2015
Page 5 of 7
55.
Producer PurchaserPlease check the applicable classification.54.
53.
SECTION O - OIL SEVERANCE
SECTION P - TIMBER SEVERANCE
67.
Distributor/WholesalerManufacturera) Please check the applicable classification.66.
65.
SECTION S - LIQUOR
64.
Native Brewery/DistributorDistributor Onlya) Please check the applicable classification.63.
62.
SECTION R - BEER
61.
PurchaserProducerPlease check the applicable classification.60.
SECTION Q - OTHER SEVERANCE
58.
Primary Processor/Producer PurchaserPlease check the applicable classification.57.
56.
SECTION T - WINE
70.
Small Farm WineryDistributor a) Please check the applicable classification.69.
68.
59.
SECTION U - CIGARETTE
74.
Shipping Account Information:Shipper Type #2:
Shipping Account Information:Shipper Type #1:
73.
Manufacturer WholesalerPlease check the applicable classification.72.
71.
b) ABC Permit Number:
b) ABC Permit Number:
b) ABC Permit Number:
c) Stateb) Citya) Mailing Address (if different from Section B) d) Zip Code
c) Stateb) Citya) Mailing Address (if different from Section B) d) Zip Code
c) Stateb) Citya) Mailing Address (if different from Section B) d) Zip Code
c) Stateb) Citya) Mailing Address (if different from Section B) d) Zip Code
c) Stateb) Citya) Mailing Address (if different from Section B) d) Zip Code
c) Stateb) Citya) Mailing Address (if different from Section B) d) Zip Code
c) Stateb) Citya) Mailing Address (if different from Section B) d) Zip Code
SECTION V - CIGARETTE PAPERS
d) Zip Codec) Stateb) Citya) Mailing Address (if different from Section B)
77.
Retailer Wholesaler ManufacturerPlease check the applicable classification.76.
75.
b) DBA (if applicable)a) Date Activity Begins in AR
b) DBA (if applicable)a) Date Activity Begins in AR
b) DBA (if applicable)a) Date Activity Begins in AR
b) DBA (if applicable)a) Date Activity Begins in AR
b) DBA (if applicable)a) Date Activity Begins in AR
b) DBA (if applicable)a) Date Activity Begins in AR
b) DBA (if applicable)a) Date Activity Begins in AR
b) DBA (if applicable)a) Date Activity Begins in AR
Revised 07/24/2015
Page 6 of 7
78.
Please check the applicable classification. Retailer Wholesaler Manufacturer
80.
79.
SECTION X - SOFT DRINK
81.
Retailer Wholesaler ManufacturerPlease check the applicable classification.82.
83.
c) Stateb) Citya) Mailing Address (if different from Section B) d) Zip Code
c) Stateb) Citya) Mailing Address (if different from Section B) d) Zip Code
SECTION W - OTHER TOBACCO PRODUCTS
d) Zip Codec) Stateb) Citya) Mailing Address (if different from Section B)
86.
Producer PurchaserPlease check the applicable classification.85.
84.
SECTION Y - BEEF
d) Zip Codec) Stateb) Citya) Mailing Address (if different from Section B)
89.
Producer PurchaserPlease check the applicable classification.88.
87.
SECTION Z - CATFISH FEED
d) Zip Codec) Stateb) Citya) Mailing Address (if different from Section B)
92.
Producer PurchaserPlease check the applicable classification.91.
90.
SECTION AA - CORN/GRAIN SORGHUM
d) Zip Codec) Stateb) Citya) Mailing Address (if different from Section B)
95.
Producer PurchaserPlease check the applicable classification.94.
93.
SECTION AB - RICE
d) Zip Codec) Stateb) Citya) Mailing Address (if different from Section B)
98.
Producer PurchaserPlease check the applicable classification.97.
96.
SECTION AC - SOYBEAN
d) Zip Codec) Stateb) Citya) Mailing Address (if different from Section B)
101.
Producer PurchaserPlease check the applicable classification.100.
99.
SECTION AD - WHEAT
d) Zip Codec) Stateb) Citya) Mailing Address (if different from Section B)
104.
Producer PurchaserPlease check the applicable classification.103.
102.
SECTION AE - BOVINE/PSEUDORABIES
b) DBA (if applicable)a) Date Activity Begins in AR
b) DBA (if applicable)a) Date Activity Begins in AR
b) DBA (if applicable)a) Date Activity Begins in AR
b) DBA (if applicable)a) Date Activity Begins in AR
b) DBA (if applicable)a) Date Activity Begins in AR
b) DBA (if applicable)a) Date Activity Begins in AR
b) DBA (if applicable)a) Date Activity Begins in AR
b) DBA (if applicable)a) Date Activity Begins in AR
b) DBA (if applicable)a) Date Activity Begins in AR
Revised 07/24/2015
d) Zip Codec) Stateb) Citya) Mailing Address (if different from Section B)
106.
105.
SECTION AF - WASTE TIRE
d) Zip Codec) Stateb) Citya) Mailing Address (if different from Section B)
108.
107.
SECTION AG - CONSTRUCTION
109.
SECTION AH - TELECOMMUNICATIONS
d) Zip Codec) Stateb) Citya) Mailing Address (if different from Section B)
110. PSC Permit Number
111.
112.
SECTION AI - MERCHANDISE VENDING (PLEASE COMPLETE AND ATTACH SUPPLEMENTAL FORM AR-1R-VEN.)
SECTION AJ - AMUSEMENT (PLEASE COMPLETE AND ATTACH SUPPLEMENTAL FORM AR-1R-AMU.)
SECTION AK - BINGO/RAFFLE (PLEASE COMPLETE AND ATTACH SUPPLEMENTAL FORM AR-1R-BRDM or AR-1R-BRLAO.)
114.
116.
118.
b) DBA (if applicable)a) Date Activity Begins in AR
b) DBA (if applicable)a) Date Activity Begins in AR
b) DBA (if applicable)a) Date Activity Begins in AR
b) DBA (if applicable)a) Date Activity Begins in AR
b) DBA (if applicable)a) Date Activity Begins in AR
b) DBA (if applicable)a) Date Activity Begins in AR
Page 7 of 7
d) Zip Codec) Stateb) Citya) Mailing Address (if different from Section B)
113.
d) Zip Codec) Stateb) Citya) Mailing Address (if different from Section B)
115.
d) Zip Codec) Stateb) Citya) Mailing Address (if different from Section B)
117.
d) Zip Codec) Stateb) Citya) Mailing Address (if different from Section B)
119.
b) DBA (if applicable)a) Date Activity Begins in AR
SECTION AL - BEAUTY PAGEANT (PLEASE COMPLETE AND ATTACH SUPPLEMENTAL FORM AR-1R-BPG.)
Revised 07/24/2015
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Ar1r AR-1R Combined Business Tax Registration Form (State of Arkansas)

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Completed 31 July 2020

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