Ap 228 1 Form – Fill Out and Use This PDF

home gardening;

horse racing, boarding or training; trail rides and zoos;

florists or similar retailers who simply maintain plants prior to sale;

wildlife management and conservation;

hunting and fi shing operations, including aerial hunting;

predator control and/or wildlife/livestock censuses or surveys;

commercial fishing; and

companion animal (pet) breeding and kennels.

ENTITY INFORMATION

Business organizations start here. If you are a sole proprietor, start on the next page, Item 10.

1.Legal business name

2.DBA (doing business as)/farm, ranch or timber operation name (for example, ABC Ranch)

3.Business organization type (Choose only one.)

Profi t Corporation (CT, CF)

General Partnership (PB, PI)

Business Trust (TF)

Nonprofi t Corporation (CN, CM)

Professional Association (AP, AF)

Trust (TR) Please submit a copy of the trust

agreement with this application.

Limited Liability Company (CL, CI)

Business Association (AB, AC)

Real Estate Investment Trust (TH, TI)

Limited Partnership (PL, PF)

Joint Venture (PV, PW)

Joint Stock Company (ST, SF)

Professional Corporation (CP, CU)

Holding Company (HF)

Estate (ES)

Other (explain)

4.

Federal Employer Identifi cation Number (FEIN)

(assigned by the Internal Revenue Service for reporting federal income taxes)

5.

List any current or past 11-digit Texas Taxpayer Number for reporting any taxes or fees

to the Texas Comptroller of Public Accounts. (If none, leave blank.)

D

D

G

6.

List Texas dyed diesel fuel license number, if any

or

A

File number

7.

If registered with Texas Secretary of State, provide Texas fi le number

8.

Non-Texas entities enter the home state/country

State/country

File number

and registration/file number

9. List all general partners or principal offi cers of this business. (Attach additional sheets, if necessary.)

Name (fi rst, middle initial, last)

SSN or FEIN

Title

Home address (street and number, city, state, ZIP code)

Phone (area code and number)

)

(

Name (fi rst, middle initial, last)

SSN or FEIN

Title

Home address (street and number, city, state, ZIP code)

Phone (area code and number)

)

(

Name (fi rst, middle initial, last)

SSN or FEIN

Title

Home address (street and number, city, state, ZIP code)

Phone (area code and number)

)

(

Proceed to the next page, Item 15.

Legal name (same as Item 1 OR Item 10)

For Comptroller Use Only

SOLE PROPRIETOR

If you are a sole proprietor, start here.

10.Name of owner (fi rst, middle initial, last)

11.DBA (doing business as)/farm, ranch or timber operation name (for example, ABC Ranch)

12.Provide one of the following: Federal Employer Identifi cation Number (FEIN), Social Security number (SSN), driver license, valid passport or national ID (i.e. CURP, IMSS)

FEIN, if you have one (assigned by the Internal Revenue

SSN

Service for reporting federal income taxes)

...............................

Type of ID ...

Number ...

Issuing country

13.

List any current or past 11-digit Texas Taxpayer Number for reporting any taxes or fees

to the Texas Comptroller of Public Accounts. (If none, leave blank.)

14.

List Texas dyed diesel fuel license number, if any

D

D

or

A

G

BUSINESS INFORMATION

All applicants continue here.

15.

Mailing address

Street number and name, P.O. Box or rural route and box number

Suite/Apt. #

City

State/province

ZIP code

County (or country, if outside the U.S.)

16.

Contact person for business records

Check this box if address is the same as Item 15.

Name (fi rst, middle initial, last)

Email

Street address (street number and name, city, state, ZIP code)

Daytime phone number

(

)

17.

Physical location - This address is for the primary physical location where business is

Check this box if address is the same as Item 15.

conducted and/or where agricultural or timber products are grown or raised for sale.

Farm, ranch or DBA (doing business as) name

Street address (include St., Ave., Ct., etc.) or rural route and box number (Do NOT use P.O. Box address—must provide physical location address.)

City

State

ZIP code

County

If this address includes a rural route and box number, provide the physical location or directions.

18. Check the box next to the principal type of exempt activity. (Choose only one.)

I operate a dairy farm

I operate a cattle feedlot

I raise and sell beef cattle

I raise and sell horses, mules, donkeys, burros and/or ponies

I raise and sell hogs and/or pigs

I raise and sell poultry and/or poultry eggs (chickens, turkeys, pheasants, quail, ostriches, emus, etc.)

I raise and sell sheep

I raise and sell goats

I raise and sell exotic or game animals or their products for human food,

fiber, leather or pelts in the regular course of business (does not include hunting operations)

I raise and sell bees and bee products (apiculture)

I raise and sell aquatic species such as fi sh and shrimp (aquaculture)

I raise grapes for commercial wine production (viticulture)

I raise and sell oilseed and/or grain crops (rice, wheat, soybean, corn, etc.)

I raise and sell vegetables

I raise and sell fruit and/or nuts

I raise and sell plants (floriculture)

I raise and sell Christmas trees (Christmas tree farm)

I raise and sell tobacco

I raise and sell cotton

I raise and sell sugarcane

I raise and sell hay or grasses (alfalfa, clover, grass, etc.)

I perform crop dusting services or other agricultural aircraft operations as defined by 14 C.F.R. Section 137.3 (does not include predator control or aerial hunting)

I am a timber producer or contract lumberjack

I am a veterinarian who makes farm/ranch calls

I am a member of FFA, 4H or am a student or teacher of a vocational agriculture course of instruction

I am a custom harvester (paid to harvest crops for others)

Legal name (same as Item 1 OR Item 10)

For Comptroller Use Only

SIGNATURE INFORMATION

19. The sole owner, all general partners, corporation president, vice-president, secretary or treasurer, managing director

Date of signature(s)

or an authorized representative must sign this application. An authorized representative must submit a written power

Month Day

Year

of attorney with application. (Attach additional sheets, if necessary.)

I understand that by signing this application, I am certifying that I am engaged in the production of agriculture and/or timber products for sale.

I understand that I am required to keep records to verify eligibility for the exemption(s) and that I will be required to pay sales or use tax on purchases that do not qualify for the exemption(s), in addition to any applicable interest and penalties. I understand that it is a criminal offense to give an exemption certificate to the seller for taxable items that I know will be used in a manner that does not qualify for the exemptions found in Tax Code Secs. 151.311, 151.316, 151.3162, 151.317 and 152.089. The offense may range from a Class C misdemeanor to a felony of the second degree.

Type or print name and title of sole owner, partner or offi cer		Driver license number/state		Sole owner, partner or officer
Type or print name and title of partner or offi cer		Driver license number/state		Partner or officer
Type or print name and title of partner or offi cer		Driver license number/state		Partner or officer

INSTRUCTIONS

To Submit Form - Sign and date the application. The completed application can be delivered in person to any of our local offices or mailed to our main office at:

Comptroller of Public Accounts 111 E. 17th St.

Austin, TX 78774-0100

After we have received your completed and signed application you will generally receive your permit in approximately three to four weeks. Incomplete applications may delay the process.

For Assistance - If you have any questions about the registration process, please see our frequently asked questions online as well as our publications at www.window.state.tx.us/taxinfo/agriculture.html. You may also contact us by email at tax.help@cpa.state.tx.us or by phone, Monday through Friday (except federal holidays), from 7:30 a.m. to 5:30 p.m. at 1-800-252-5555 or 512-463-4600.

Federal Privacy Act - Disclosure of your Social Security number is required and authorized under law, for the purpose of tax adminis- tration and identifi cation of any individual affected by applicable law. 42 U.S.C. §405(c)(2)(C)(i); Tex. Govt. Code §§403.011 and 403.078. Release of information on this form in response to a public information request will be governed by the Public Information Act, Chapter 552, Government Code, and applicable federal law.

You have certain rights under Chapters 552 and 559, Government Code, to review, request and correct information we have on file about you. Contact us at the address or phone number listed on this form.