Ar 1R Form PDF Details

The AR-1R form, issued by the Arkansas Department of Finance and Administration, encompasses a comprehensive business tax registration process designed for entities within the state. This pivotal document caters to various business needs, including the initiation of new businesses, expansion through additional locations, modification in ownership, and the introduction of new tax types, ensuring a structured pathway for compliance and operational readiness. Catering to a wide array of industries and business activities, the form covers tax registrations for sales and use, specific commodities like alcoholic beverages, motor fuels, and several forms of severance taxes among others. Moreover, it demands detailed information regarding owner and responsible party particulars, heavily emphasizing the need for accuracy and transparency. The form not only outlines the responsibilities and prerequisites for entities in Arkansas but also serves as a gateway for businesses to access ATAP (Arkansas Taxpayer Access Point), facilitating online registrations and transactions. Critical components such as a declaration under penalty of perjury reinforce the importance of integrity within the business registration process, making it clear that the AR-1R form is a fundamental step towards establishing a legitimate business presence in Arkansas.

QuestionAnswer
Form NameAr 1R Form
Form Length7 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 45 sec
Other namesar arkansas form, arkansas business registration form, form ar, ar 1r

Form Preview Example

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:

New Business - Never Registered

Add Additional Location

Add Additional Tax Type

Ownership Change

ATAP

Third Party Access

SECTION A - TAX TYPES

1.

Type of Registration: (Check all that apply)

 

 

 

Sales and Use

Dyed Diesel

Liquor

Catfish Feed

Construction

Withholding Wage

Brine Severance

Wine

Corn/Grain Sorghum

Telecommunications

Withholding Pass Through

Natural Gas Severance

Cigarette

Rice

Merchandise Vending

Withholding Pension

Oil Severance

Cigarette Papers

Soybean

Amusement

Corporation Income

Timber Severance

Other Tobacco Products

Wheat

Bingo/Raffle

Partnership Income

Other Severance

Soft Drink

Bovine/Pseudorabies

Beauty Pageant

Motor Fuel

Beer

Beef

Waste Tire

 

SECTION B - OWNER INFORMATION

 

Ownership Type: (Check only one)

 

 

 

 

 

 

Corporation

Partnership

LLC

Government

Fiduciary / Trust

Non-Profit

 

 

 

 

 

 

2.

Federal Identification Number (FEIN): (Required)

-

 

 

 

 

 

 

 

 

 

 

OR

 

 

 

 

 

 

 

 

 

 

 

 

 

Sole Proprietor

 

 

 

 

 

 

 

 

 

 

 

 

Social Security Number: (Required)

-

-

 

 

Owner's Name: (Enter full legal name of Business. If you selected Sole Proprietor owner type, enter first name, middle name, and last name.)

3.

 

DBA: (Enter full Doing Business As Name, if applicable.)

 

 

4.

 

 

 

 

 

 

 

 

 

 

Primary Business Activity: (Enter the NAICS code that best matches your business (see instructions) and describe your business activity.

5.

 

 

 

 

 

 

 

a) NAICS

b) Brief Description

 

 

 

 

 

 

 

 

 

 

 

Physical Location Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a) Street (Not PO Box)

 

 

 

b) Unit

c) Phone Number: (Include Area Code)

6.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

d) City

 

e) County

f) State

g) Zip Code

 

 

 

 

 

 

 

 

 

Mailing Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a) In Care Of

 

 

b) Street Address or PO Box

 

 

7.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

c) City

d) State

e) Zip Code

Revised 07/24/2015

Page 1 of 7

 

 

 

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.

 

 

 

 

 

 

 

 

 

 

 

 

a) Name of Responsible Party

 

 

 

 

b) SSN or FEIN

 

 

 

 

 

 

 

 

c) Title

d) Effective Date

 

e) Phone Number (Include Area Code)

f) E-Mail Address

8.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

g) Street Address or PO Box

 

 

h) City, State, Zip Code

 

 

 

 

 

 

 

 

 

 

a) Name of Responsible Party

 

 

 

 

b) SSN or FEIN

 

 

 

 

 

 

 

 

c) Title

d) Effective Date

 

e) Phone Number (Include Area Code)

f) E-Mail Address

9.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

g) Street Address or PO Box

 

 

h) City, State, Zip Code

 

 

 

 

 

 

 

 

 

 

a) Name of Responsible Party

 

 

 

 

b) SSN or FEIN

 

 

 

 

 

 

 

 

c) Title

d) Effective Date

 

e) Phone Number (Include Area Code)

f) E-Mail Address

10.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

g) Street Address or PO Box

 

 

h) City, Sate, Zip Code

 

 

 

 

 

 

 

 

 

 

a) Name of Responsible Party

 

 

 

 

b) SSN or FEIN

 

 

 

 

 

 

 

 

c) Title

d) Effective Date

 

e) Phone Number (Include Area Code)

f) E-Mail Address

11.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

g) Street Address or PO Box

 

 

h) City, State, Zip Code

 

 

 

 

 

 

 

 

 

 

Contact Information

 

 

 

 

 

 

 

 

 

 

 

 

a) Name

 

 

b) Title

c) Contact Phone Number: (including area code)

12.

 

 

 

 

 

 

 

 

 

 

 

 

 

d) E-Mail Address

e) Fax Number

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

Revised 07/24/2015

Page 2 of 7

SECTION E - SALES AND USE

 

a) Date Activity Begins in AR

 

 

 

b) DBA (if applicable)

 

 

 

 

 

 

 

 

 

14.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

c) NAICS

 

d) Description of Business Activity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a) Physical Location Address (if different from Section B)

 

 

 

b) City

 

 

 

 

c) County

 

d) State

e) Zip Code

15.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

f) Mailing Address (if different from Section B)

 

 

 

 

 

 

g) City

 

h) State

i) Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

16.

a) Are you renting/leasing the property?

 

 

Yes

 

No

b) If yes, provide a copy of the Lease Agreement. (Required)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a) Did you purchase the inventory, fixtures, or equipment of an established business?

 

Yes

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

17.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b) If Yes, attach a copy of the Bill of Sale and enter name of previous owner:

 

 

 

 

 

 

c) Former Business Account ID:

 

 

 

 

 

 

 

 

 

 

 

 

18.

a) What is the dollar value of your inventory?

 

 

b) Equipment and Fixtures?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Does this business sell or serve alcoholic beverages? If so, please check each that applies and enter the ABC permit number:

19.

 

 

 

 

 

 

 

 

 

 

 

 

Beer

Wine

Liquor

Mixed Drink

 

Private Club

Off-Premises Consumption

On-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.

Special Additional Taxes: Check all that apply to your type of business. See instructions for detailed information on each tax.

23.

Short Term Rental Vehicle Tax

Tourism Tax

Wholesale Vending Tax

Sell Aviation Fuel

 

Short Term Rental Tax

Aviation Tax

Residential Moving Tax

 

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

 

 

 

 

 

 

 

Yes

 

 

No

 

 

 

 

 

2.

Do you perform a taxable service in Arkansas?

 

 

 

 

 

 

 

24.

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.

SECTION F - WITHHOLDING WAGE

25.

a) Date Arkansas Withholding required

 

b) FEIN:

c) DBA (if applicable)

 

 

 

 

 

 

 

 

 

 

26.

a) Mailing Address (if different from Section B)

 

 

 

b) City

c) State

d) Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION G - WITHHOLDING PASS THROUGH

 

 

 

 

 

 

 

 

 

27.

a) Date Arkansas Withholding required

 

b) FEIN:

c) DBA (if applicable)

 

 

 

 

 

 

 

 

 

 

28.

a) Mailing Address (if different from Section B)

 

 

 

b) City

c) State

d) Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION H - WITHHOLDING PENSION

 

 

 

 

 

 

 

 

 

29.

a) Date Arkansas Withholding required

 

b) FEIN:

c) DBA (if applicable)

 

 

 

 

 

 

 

 

 

 

30.

a) Mailing Address (if different from Section B)

 

 

 

b) City

c) State

d) Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Revised 07/24/2015

Page 3 of 7

SECTION I - CORPORATE INCOME (INCLUDING SUB S ELECTION)

31.

a) Date Activity Begins in AR

 

b) DBA (if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

32.

a) Mailing Address (if different from Section B)

 

 

 

 

 

 

 

 

b) City

 

 

 

c) State

d) Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For Sub S Election please complete and attach form AR1103.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION J - PARTNERSHIP INCOME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

33.

a) Date Activity Begins in AR

 

b) DBA (if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

34.

a) Mailing Address (if different from Section B)

 

 

 

 

 

 

 

 

b) City

 

 

 

c) State

d) Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION K - MOTOR FUEL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a) Date to start purchasing or importing Fuel into Arkansas:

 

 

 

b) DUNS Number:

 

 

 

 

 

35.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

c) DBA (if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

36.

a) Mailing Address (if different from Section B)

 

 

 

 

 

 

 

 

b) City

 

 

 

c) State

d) Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please check the Fuel Type you plan to import or purchase for resale or distribution in Arkansas.

 

 

 

 

 

37.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Gasoline

Distillate Special Fuels

Liquefied Gas

 

 

 

 

Natural Gas

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If importing or exporting Fuel, what means of Transport will you utilize?

 

 

 

 

 

 

 

 

 

 

 

38.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Truck

Rail

 

Barge

 

 

 

 

Pipeline

 

 

 

 

 

 

 

 

 

 

 

 

 

39.

Do you transport petroleum in any device having a carrying capacity exceeding 9,500 gallons?

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

40.

a) Have you previously held a Motor Fuel Tax License in Arkansas?

Yes

 

No

 

b) License Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

41.

Are you acquiring an existing business that held a Motor Fuel Tax License?

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

42.

a) Company Name

 

 

 

 

b) Account Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

43.

Do you have Bulk Storage Facilities in Arkansas?

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

44.

Estimate the number of gallons to be reported in the State of Arkansas each month.

 

a) Gasoline

 

 

b) Diesel

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If you are granted a License, do you expect to:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Import Fuel into Arkansas?

Have any Transactions in Dyed Petroleum Products?

Sell Fuel to other Arkansas Licensed Distributors?

45.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Export Fuel from Arkansas?

Take Ownership of Fuel at an Arkansas Terminal?

Sell Fuel to Non-Licensed Reseller or Consumer?

 

Blend Gasoline or Diesel Fuel with Alcohol or Ethanol, other Petroleum Products, Agricultural or Waste of such Products?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION L - DYED DIESEL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

46.

a) Date Activity Begins in AR

 

b) DBA (if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

47.

a) Mailing Address (if different from Section B)

 

 

 

 

 

 

 

 

b) City

 

 

 

c) State

d) Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION M - BRINE SEVERANCE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

48.

a) Date Activity Begins in AR

 

b) DBA (if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

49.

Please check the applicable classification.

 

Producer

 

 

Purchaser

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

50.

a) Mailing Address (if different from Section B)

 

 

 

 

 

 

 

 

b) City

 

 

 

c) State

d) Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION N - NATURAL GAS SEVERANCE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a) Date Activity Begins in AR

 

b) DBA (if applicable)

 

 

 

 

 

 

 

 

 

 

 

51.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

c) Please check the applicable classification.

Producer

Purchaser

 

d) AR Oil/Gas Commission Operator Number (if applicable):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

52.

a) Mailing Address (if different from Section B)

 

 

 

 

 

 

 

 

b) City

 

 

 

c) State

d) Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Revised 07/24/2015

Page 4 of 7

SECTION O - OIL SEVERANCE

53.

a) Date Activity Begins in AR

 

b) DBA (if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

54.

Please check the applicable classification.

 

Producer

Purchaser

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

55.

a) Mailing Address (if different from Section B)

 

 

 

 

b) City

 

c) State

d) Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION P - TIMBER SEVERANCE

 

 

 

 

 

 

 

 

 

 

 

 

 

56.

a) Date Activity Begins in AR

 

b) DBA (if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

57.

Please check the applicable classification.

 

Primary Processor/Producer

Purchaser

 

 

 

 

 

 

 

 

 

 

 

 

 

 

58.

a) Mailing Address (if different from Section B)

 

 

 

 

b) City

 

c) State

d) Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION Q - OTHER SEVERANCE

 

 

 

 

 

 

 

 

 

 

 

 

 

59.

a) Date Activity Begins in AR

 

b) DBA (if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

60.

Please check the applicable classification.

 

Producer

Purchaser

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

61.

a) Mailing Address (if different from Section B)

 

 

 

 

b) City

 

c) State

d) Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION R - BEER

 

 

 

 

 

 

 

 

 

 

 

 

 

62.

a) Date Activity Begins in AR

 

b) DBA (if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

63.

a) Please check the applicable classification.

Distributor Only

Native Brewery/Distributor

b) ABC Permit Number:

 

 

 

 

 

 

 

 

 

 

 

64.

a) Mailing Address (if different from Section B)

 

 

 

 

b) City

 

c) State

d) Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION S - LIQUOR

 

 

 

 

 

 

 

 

 

 

 

 

 

65.

a) Date Activity Begins in AR

 

b) DBA (if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

66.

a) Please check the applicable classification.

Manufacturer

Distributor/Wholesaler

b) ABC Permit Number:

 

 

 

 

 

 

 

 

 

 

 

67.

a) Mailing Address (if different from Section B)

 

 

 

 

b) City

 

c) State

d) Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION T - WINE

 

 

 

 

 

 

 

 

 

 

 

 

 

68.

a) Date Activity Begins in AR

 

b) DBA (if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

69.

a) Please check the applicable classification.

Distributor

Small Farm Winery

b) ABC Permit Number:

 

 

 

 

 

 

 

 

 

 

 

70.

a) Mailing Address (if different from Section B)

 

 

 

 

b) City

 

c) State

d) Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION U - CIGARETTE

 

 

 

 

 

 

 

 

 

 

 

 

 

71.

a) Date Activity Begins in AR

 

b) DBA (if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

72.

Please check the applicable classification.

 

Manufacturer

Wholesaler

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Shipper Type #1:

 

Shipping Account Information:

 

 

 

 

 

73.

 

 

 

 

 

 

 

 

 

 

Shipper Type #2:

 

Shipping Account Information:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

74.

a) Mailing Address (if different from Section B)

 

 

 

 

b) City

 

c) State

d) Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION V - CIGARETTE PAPERS

 

 

 

 

 

 

 

 

 

 

 

 

75.

a) Date Activity Begins in AR

 

b) DBA (if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

76.

Please check the applicable classification.

 

Retailer

Wholesaler

Manufacturer

 

 

 

 

 

 

 

 

 

 

 

77.

a) Mailing Address (if different from Section B)

 

 

 

 

b) City

 

c) State

d) Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Revised 07/24/2015

Page 5 of 7

SECTION W - OTHER TOBACCO PRODUCTS

78.

a) Date Activity Begins in AR

b) DBA (if applicable)

 

 

 

 

 

 

 

 

 

 

 

79.

Please check the applicable classification.

Retailer

Wholesaler

Manufacturer

 

 

 

 

 

 

 

 

 

 

80.

a) Mailing Address (if different from Section B)

 

 

 

b) City

c) State

d) Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION X - SOFT DRINK

 

 

 

 

 

 

 

 

 

 

 

81.

a) Date Activity Begins in AR

b) DBA (if applicable)

 

 

 

 

 

 

 

 

 

 

 

82.

Please check the applicable classification.

Retailer

Wholesaler

Manufacturer

 

 

 

 

 

 

 

 

 

 

83.

a) Mailing Address (if different from Section B)

 

 

 

b) City

c) State

d) Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION Y - BEEF

 

 

 

 

 

 

 

 

 

 

 

84.

a) Date Activity Begins in AR

b) DBA (if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

85.

Please check the applicable classification.

Producer

Purchaser

 

 

 

 

 

 

 

 

 

 

 

 

86.

a) Mailing Address (if different from Section B)

 

 

 

b) City

c) State

d) Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION Z - CATFISH FEED

 

 

 

 

 

 

 

 

 

87.

a) Date Activity Begins in AR

b) DBA (if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

88.

Please check the applicable classification.

Producer

Purchaser

 

 

 

 

 

 

 

 

 

 

 

 

89.

a) Mailing Address (if different from Section B)

 

 

 

b) City

c) State

d) Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION AA - CORN/GRAIN SORGHUM

 

 

 

 

 

 

 

 

 

90.

a) Date Activity Begins in AR

b) DBA (if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

91.

Please check the applicable classification.

Producer

Purchaser

 

 

 

 

 

 

 

 

 

 

 

 

92.

a) Mailing Address (if different from Section B)

 

 

 

b) City

c) State

d) Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION AB - RICE

 

 

 

 

 

 

 

 

 

 

 

93.

a) Date Activity Begins in AR

b) DBA (if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

94.

Please check the applicable classification.

Producer

Purchaser

 

 

 

 

 

 

 

 

 

 

 

 

95.

a) Mailing Address (if different from Section B)

 

 

 

b) City

c) State

d) Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION AC - SOYBEAN

 

 

 

 

 

 

 

 

 

 

 

96.

a) Date Activity Begins in AR

b) DBA (if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

97.

Please check the applicable classification.

Producer

Purchaser

 

 

 

 

 

 

 

 

 

 

 

 

98.

a) Mailing Address (if different from Section B)

 

 

 

b) City

c) State

d) Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION AD - WHEAT

 

 

 

 

 

 

 

 

 

 

 

99.

a) Date Activity Begins in AR

b) DBA (if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

100.

Please check the applicable classification.

Producer

Purchaser

 

 

 

 

 

 

 

 

 

 

 

 

101.

a) Mailing Address (if different from Section B)

 

 

 

b) City

c) State

d) Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION AE - BOVINE/PSEUDORABIES

 

 

 

 

 

 

 

 

 

102.

a) Date Activity Begins in AR

b) DBA (if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

103.

Please check the applicable classification.

Producer

Purchaser

 

 

 

 

 

 

 

 

 

 

 

 

104.

a) Mailing Address (if different from Section B)

 

 

 

b) City

c) State

d) Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Revised 07/24/2015

Page 6 of 7

SECTION AF - WASTE TIRE

105.

a) Date Activity Begins in AR

b) DBA (if applicable)

 

 

 

 

 

 

 

 

 

 

106.

a) Mailing Address (if different from Section B)

 

 

b) City

 

c) State

d) Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION AG - CONSTRUCTION

 

 

 

 

 

 

 

 

107.

a) Date Activity Begins in AR

b) DBA (if applicable)

 

 

 

 

 

 

 

 

 

108.

a) Mailing Address (if different from Section B)

 

 

b) City

 

c) State

d) Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION AH - TELECOMMUNICATIONS

 

 

 

 

 

 

 

 

109.

a) Date Activity Begins in AR

b) DBA (if applicable)

 

 

 

 

 

 

 

 

 

 

110.

PSC Permit Number

 

 

 

 

 

 

 

 

 

 

 

 

 

111.

a) Mailing Address (if different from Section B)

 

 

b) City

 

c) State

d) Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION AI - MERCHANDISE VENDING (PLEASE COMPLETE AND ATTACH SUPPLEMENTAL FORM AR-1R-VEN.)

 

 

 

 

 

 

112.

a) Date Activity Begins in AR

b) DBA (if applicable)

 

 

 

 

 

 

 

 

 

113.

a) Mailing Address (if different from Section B)

 

 

b) City

 

c) State

d) Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION AJ - AMUSEMENT (PLEASE COMPLETE AND ATTACH SUPPLEMENTAL FORM AR-1R-AMU.)

 

 

 

 

 

 

 

114.

a) Date Activity Begins in AR

b) DBA (if applicable)

 

 

 

 

 

 

 

 

 

115.

a) Mailing Address (if different from Section B)

 

 

b) City

 

c) State

d) Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION AK - BINGO/RAFFLE (PLEASE COMPLETE AND ATTACH SUPPLEMENTAL FORM AR-1R-BRDM or AR-1R-BRLAO.)

 

 

 

 

 

 

116.

a) Date Activity Begins in AR

b) DBA (if applicable)

 

 

 

 

 

 

 

 

 

117.

a) Mailing Address (if different from Section B)

 

 

b) City

 

c) State

d) Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION AL - BEAUTY PAGEANT (PLEASE COMPLETE AND ATTACH SUPPLEMENTAL FORM AR-1R-BPG.)

 

 

 

 

 

 

 

118.

a) Date Activity Begins in AR

b) DBA (if applicable)

 

 

 

 

 

 

 

 

 

119.

a) Mailing Address (if different from Section B)

 

 

b) City

 

c) State

d) Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Revised 07/24/2015

Page 7 of 7

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form ar writing process outlined (stage 1)

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