North Carolina > Statewide > Department Of Revenue
Application For State Privilege License B-202A - North Carolina
| Application For State Privilege License Form. This is a North Carolina form and can be used in Department Of Revenue Statewide . |
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B-202A Web 12-12 Application for State Privilege License North Carolina Department of Revenue For Office Use Only and ending June 30, For the year beginning July 1, First-Time Applicant Renewal Applicant If first-time applicant, enter start date of activity that requires this license. If renewal applicant, enter account number/NCDOR ID for this license. Part 1. Professional Individuals First Name Social Security Number M.I. Last Name Daytime Phone (Include area code) Name of Business Where Professional Individual Is Employed (optional) Address Where License Is To Be Mailed (This address is printed on the license.) City State Zip Code (5 Digits) County Enter Code Number and License Description from Table on Reverse Part 2. Loan Agencies, Check Cashers, or Pawnbrokers Legal Name of Business Federal Employer ID Number Street Address of Business City State Loan Agency Check Casher Pawnbroker Business Phone (Include area code) Zip Code (5 Digits) County Address Where License Is To Be Mailed (If different from street address) City State Zip Code (5 Digits) Part 3. Computation of Privilege License Tax 1. Total Privilege License Tax Due (From Table on Reverse) 2. Penalty 3. Interest 4. Total Payment Due (Add Lines 1 through 3) $, Date: . . . . Signature: I certify that, to the best of my knowledge, this application is accurate and complete. Attach your check or money order to this application. Payment must be in the form of U.S. currency from a domestic bank. North Carolina Department of Revenue, P.O. Box 25000, Raleigh, NC 27640-0100 American LegalNet, Inc. www.FormsWorkFlow.com Page 2 B-202A Web 12-12 Instructions General Information: Use this form if you are beginning in business and do not have the required State privilege license. If you are renewing your State privilege license, it is preferable to use the renewal notice you received from the Department of Revenue instead of this form. Use a separate form for each profession and each business location. Professional individuals complete Part 1. Loan agencies, check cashers, or pawnbrokers complete Part 2. Fill in the applicable circle for Parts 1 and 2 to indicate whether this application is a first time applicant or a renewal applicant. Complete the form in blue or black ink. Do not send a photocopy of this form. The original form is printed in pink and black ink. Individuals who engage in the practice of a profession listed in the following table and loan agencies, check cashers, and pawnbrokers must obtain a State privilege license and pay a tax before they engage in business. For purposes of this tax, an individual engages in the practice of a profession when the person represents to the public that the person is engaged in the profession. The tax does not apply to an individual who is a salaried employee of a governmental unit unless either the unit charges a fee for the services of the employed individual and the individual receives part or all of the fee, either directly or indirectly, or the individual engages in practice outside the salaried employment. Code Number 427 429 430 License Description Accountant Certified Public Accountant Assistant Accountants (Per assistant issued in the name of the manager) _____(Number of Assistants) X $12.50 Architect Art of Healing Attorney Chiropodist Chiropractor Dentist Embalmer Engineer Land Surveyor Landscape Architect Naturopath Tax $50.00 $50.00 Code Number 442 443 444 445 446 447 448 449 450 451 452 453 567 568 569 License Description Tax 431 432 433 434 435 436 437 438 439 440 441 $ $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 Ophthalmologist $50.00 Optician $50.00 Optometrist $50.00 Osteopath $50.00 Photographer $50.00 Photographer's Agent $50.00 Physician $50.00 Podiatrist $50.00 Psychologist $50.00 Real Estate (Only one license required if engaged in multiple real estate activities) $50.00 Veterinarian $50.00 Licensed Home Inspector $50.00 Loan Agency $250.00 Check Casher $250.00 Pawnbroker $250.00 Tax Year: The State privilege license tax is an annual tax that is imposed on a fiscal year basis that begins July 1 and ends the following June 30. Enter the appropriate year in the space provided. A first-time applicant must enter the date the applicant will start to engage in the activity that is subject to tax. The tax must be paid before the applicant engages in the activity. An applicant who starts to engage in an activity after July 1 of a year may not prorate the tax. Name and Tax Identification Number: If you are a professional individual other than an assistant accountant, enter your name and social security number. Assistant accountants should enter the name and social security number of their principal or manager. A license issued to an individual who engages in a profession is issued as a personal privilege license and is not issued in the name of a firm or another business entity. If you are a loan agency, check casher, or pawnbroker, enter the legal name of the business, any trade name of the business, and the federal employer identification number of the business. A license issued to a loan agency, check casher, or pawnbroker is issued in the business name. Due Date: An initial annual State privilege license tax is due before the start of the activity that requires the license. An application for an initial privilege license made after the start date of the activity is subject to penalties for failure to obtain a license (5% per month, with 25% maximum and $5 minimum) and failure to pay a tax when due (10% of tax due, $5 minimum). A renewal of an annual State privilege license tax is due by July 1. A late renewal application is subject to penalties for failure to obtain a license (5% per month, with 25% maximum and $5 minimum) and failure to pay a tax when due (10% of tax due, $5 minimum). Interest will be due on the unpaid tax. The rate is set semiannually by the Secretary of Revenue and is available on the Department's website, www.dornc.com. Change of Name or Address: If your preprinted name or address on the privilege license is incorrect, please call the Department's Form Line at (877) 252-3052 (toll-free) to request a Form NC-AC, Business Address Correction, or you may write to Privilege License Tax, Customer Service, PO Box 1168, Raleigh, NC 27602-1168. Questions: If you have questions about this form, call toll free 1-877-252-3052. American LegalNet, Inc. www.FormsWorkFlow.com
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