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Application For Louisiana Revenue Account Number R-16019 - Louisiana

Application For Louisiana Revenue Account Number Form. This is a Louisiana form and can be used in Department Of Revenue Statewide .
 Fillable pdf Last Modified 5/14/2014
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R-16019 (5/08) CR1 Application for Louisiana Revenue Account Number P.O. Box 201 Baton Rouge, LA 70821-0201 (225) 219-7318 Date of application 1. A. Sales/ Use Louisiana General Sales Tax Statewide Hotel/Motel Jefferson Parish Hotel/Motel Orleans Parish Hotel/Motel Orleans Parish Restaurant N.O. Airport Food Establishments Motor Vehicle Lessors/Rentors Reason for applying B. C. D. E. Withholding Vehicle Rental Excise Severance Oil and Gas Classification Taxpayer Only Producer Only Producer/Taxpayer F. Other _________________________ _________________________ _________________________ For office use only. 2. 3. A. Started new business C. Other (specify) B. Purchased ongoing business: Name of previous owner Indicate the account number you use for each tax filed with the Louisiana Department of Revenue. LA Corp. Tax Number None LA Sales Tax Number None LA Excise Taxes Number LA Withholding Tax Number None LASeverance Tax Number None None LANatural Resource Number None 4. 5. 6. A. B. A. B. A. B. Legal name(s) Trade name of business Business location address (NO P.O. Box or General Delivery) City and state Address for receiving tax forms and correspondence (If same location, write "same".) City and State Telephone ( ) __________________ C. ZIP C. B. Partnership 9. ZIP D. ( ) Telephone E. Additional mailing address(es) attached F. Other None 7. 8. Type of organization: (required) A. Individual C. Corporation Federal Employer ID Number D. Governmental E. Nonprofit U.S. NAICS Code 10. If sole owner (individual): Name Home address 11. If corporation or partnership: name, title, Social Security Number, home address, and telephone number of officers or partners 12. A. Name Address Name Address Title Title SSN Telephone ( SSN Telephone SSN ) ( ) _________________ ) _________________ Telephone ( B. 13. Permits -Sellers of liquor, beer, or wine (wholesale or retail), must obtain a permit from the Office of Alcohol and Tobacco Control. A permit from the Louisiana State Police Gaming Division must be obtained by sellers of lottery tickets or operators of video poker games. Indicate permit number(s) that you currently hold. A. Lottery Permit Number Alcohol Permit Number VPG Permit Number B. Expiration Month/Year_______________________________ Expiration Month/Year_______________________________ Mo. Day Yr. Domestic Foreign Fiscal Month Louisiana Charter Number (if known) _________________________ State of incorporation (if not Louisiana) ___________________ Expiration Month/Year ___________________________ B. C. 14. A. Corporation Income/Franchise: Date charter filed with Louisiana Secretary of State 15. Sales or Use Tax: Date business begins sales operations from this location 16. Withholding Tax: (See instructions.) Select filing frequency. quarterly monthly semi-monthly 17. Severance Tax: Select filing frequency. quarterly monthly 45-day 18. Description of business: (required) I affirm that the information given on this application is true and Signature of preparer correct. Signature of applicant Title Date (mm/dd/yyyy) 1500 American LegalNet, Inc. www.FormsWorkFlow.com
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