Cr 0100 Form PDF Details

The CR 0100 form is a comprehensive document essential for businesses operating within Colorado, serving as the foundation for managing and complying with state tax obligations. As the Colorado Business Registration form, it encompasses various sections that demand accurate and detailed information regarding the business, ranging from the basic details like the business name and the Federal Employer Identification Number (FEIN) to the specifics of payroll, the nature of products or services offered, and the location of business operations. Whether you are initiating a new enterprise, transferring ownership, or updating your business details due to a change in operations or location, this form plays a pivotal role in ensuring your business aligns with Colorado's Department of Revenue requirements. Furthermore, it addresses unemployment insurance, a crucial aspect for employers to understand to maintain compliance with state labor laws. It's notable that certain sections of the form, such as trade name registration and various licensing fees are also highlighted, illustrating the form's integral role in facilitating a wide spectrum of business registration and administrative functions within the state. The filing process is elaborated with a clear instruction guide, ensuring that applicants can submit their information accurately to avoid common pitfalls. Thus, the CR 0100 form stands as a vital document for Colorado businesses, encapsulating business registration requirements and tax obligations in a structured and accessible manner.

QuestionAnswer
Form NameCr 0100 Form
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesco cr 0100, cr0100, cr 0100 colorado, colorado business registration form

Form Preview Example

CR 0100 Web (12/11/06)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Department Use Only

 

 

 

1375 Sherman Street

COLORADO BUSINESS REGISTRATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(303) 238-SERV (7378)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Denver CO 80261-0009

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PLEASE PRESS FIRMLY AND PRINT CLEARLY - INSTRUCTIONS FOR THIS FORM ARE IN THE PUBLICATION CR 101

 

 

 

 

 

 

 

 

 

INFORMATION

 

 

 

 

 

 

 

 

 

 

1. REASON FOR FILING THIS APPLICATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

THE REVERSE SIDE

 

 

Original Application

 

Change of Ownership

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OF THIS PAGE

 

 

Do you have a Dept of Revenue Account Number?

 

 

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MUST BE COMPLETED

 

IF Yes, Account # _______________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Do you want this number assigned to new location?

 

Yes

 

 

No

 

 

 

 

 

 

 

 

 

GENERAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.

Indicate Type of Organization

 

 

 

 

Estate

 

 

 

Other Non-Profit

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Individual

 

 

 

 

Limited Liability Limited

Government

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

General Partnership

 

 

 

Partnership (LLLP)

Joint Venture

 

Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Limited Partnership

 

 

 

Corporation

 

 

Trust

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A–

 

 

 

Limited Liability Company (LLC)

 

 

 

'S' Corporation

 

 

Non-profit 501 (C)(3)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Limited Liability Partnership (LLP)

 

 

 

Association

 

 

(Please enclose copy of the IRS letter of exemption.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SIDE A

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1a. Taxpayer Name (Owner, Partners or Corporate Name) (Last, First, Middle)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1b.

Taxpayer ID Required (See page 3)

 

 

 

 

INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2a. Trade Name/Doing Business As (If Applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2b.

Federal Employer Identification Number (FEIN)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3a. Street Address of Principal Place of Business in Colorado

 

 

City

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State

 

ZIP Code

 

 

 

 

ORGANIZATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3b.

County

 

 

 

 

 

 

 

 

If business is within limits of a city, what city?

 

 

 

Telephone

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

 

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4a. In Care Of (C/O)

 

 

 

 

 

 

 

4b. Mailing Address (If Different From Above) (Include Unit #)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B–

City

 

 

 

 

 

 

 

 

 

State

 

 

 

ZIP Code

 

 

 

 

 

 

 

 

 

Telephone

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

 

)

 

 

 

 

 

 

 

5. Bank Name (If Available)

 

 

 

 

 

 

 

Bank Address

 

 

 

 

 

 

 

 

 

 

 

Bank Account Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6.

 

First Day of Payroll (Mo/Day/Yr)

 

Payroll Records Location (List Address )

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Payroll Records Telephone

 

 

 

 

10b)-1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

 

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7.

 

What products and/or services do you provide? (Complete Section "H")

Do you sell motor vehicle tires?

Yes

No

Is your business in a special taxing district?

Yes

No

 

 

completed

 

 

 

 

 

 

 

 

 

 

 

 

Do you rent out items for 30 days or less?

Yes

 

No

 

 

 

 

 

 

 

8b.

Address (Residence or P.O. Box, Street, City, State, ZIP Code)

 

 

Title

 

 

 

Social Security #

 

 

 

 

 

 

Telephone

 

 

 

 

 

 

 

8a.

Owner/Partner/Corp. Officer

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Federal Employer Identification Number (FEIN)

 

 

 

be

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

 

)

 

 

 

 

 

MUST

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9a.

Owner/Partner/Corp. Officer

 

 

 

 

 

 

 

Title

 

 

 

Social Security #

 

 

 

 

 

 

Federal Employer Identification Number (FEIN)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

section

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9b.

Address (Residence or P.O. Box, Street, City, State, ZIP Code)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Telephone

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

 

)

 

 

 

 

 

(This

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If you acquired the business in whole or in part, complete the following:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10a. Prior Taxpayer Name

 

 

 

 

 

 

 

 

 

 

 

Date of Acquisition

 

 

 

 

 

 

Prior Taxpayer UI Tax Account Number

 

 

 

 

 

10b. Address

 

 

 

City

 

 

State

ZIP Code

 

 

 

1.

If Seasonal, mark

Jan.

Apr.

July

Oct.

Period Covered

 

E – FEES

 

 

Feb.

May

Aug.

Nov.

 

 

 

 

 

each business month.

From

To

 

 

 

 

Mar.

June

Sept.

Dec.

 

 

 

 

 

 

 

 

 

 

 

 

 

2a.

Filing Frequency: If sales tax collected is:

2b. First Day of Sales (Mo/Day/Yr)

 

Mo

Mo

(0020- State Sales Tax

 

 

TAX

 

 

 

 

 

 

$15.00/month or less - Annually

 

 

 

 

Yr

Yr

810)

Deposit

(355) $

 

 

 

 

 

 

 

 

SALES

 

Under $300/month - Quarterly

 

Revenue Registration Account Number (Dept. Use Only)

Mo

Mo

(0080- Sales Tax

 

 

 

 

Wholesale only - Annually

 

Mo

Mo

 

 

 

 

 

 

 

$300/month or more - Monthly

 

 

 

 

Yr

Yr

750)

License

(999) $

 

 

 

 

 

 

 

 

 

3. Indicate which applies to you:

 

 

 

 

 

 

(0100- Wholesale

 

 

 

C

 

 

 

 

 

 

750)

License

(999) $

 

 

Wholesaler

 

Charitable

RTD

 

Yr

Yr

 

 

 

 

 

Mo

Mo

(1000- Wage

 

 

 

 

 

Retail-Sales

 

 

CD

 

 

 

0.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Withholding

(999) $

WITHHOLDING-D

 

Retailers-Use

 

 

FD

 

Yr

Yr

750)

 

$7,000 - $49,999/Year - Monthly

 

 

 

 

Colo. Dept. of Revenue

TOTAL

$

 

1.

Filing Frequency: If wage withholding amount is

 

2. Oil/Gas

Mo

Mo

(0160- Charitable

 

 

 

 

 

$1 - $6,999/Year - Quarterly

$50,000+/Year - Weekly

 

Withholding

Yr

Yr

750)

License

(999) $

 

 

 

 

Make check payable to

 

 

 

 

 

 

 

Must file by Electronic Funds Transfer

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SIGNATURE-F

Both White Pages Must Be Returned.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I declare under penalty of perjury in the second degree that the statements made in this application are true and complete to the best of my knowledge.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SIGNATURE of Owner, Partner, or Corporate Officer Required

 

 

 

 

 

Title

 

 

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OFFICE USE ONLY Account Type

 

 

NAICS

 

 

Org

LC

 

LD

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

QD

 

 

SC

 

IA

 

 

Sig N

TR-1

 

 

Date

 

Tech Sig

 

 

SEE PAGE 3 FOR RETURN CHECK POLICY

G – UNEMPLOYMENT INSURANCE 303-318-9100 (Denver-metro area), 1-800-480-8299 toll-free

 

 

 

 

SIDE B

 

1.

Has the taxpayer paid any individual that is considered contract or subcontract labor?

Yes

No

N/A

 

If Yes, describe the occupation(s)

 

 

 

 

 

2.

Does the business activity consist of employee leasing or management of other businesses?

Yes

No

N/A

3.

If the taxpayer is a corporation, are any officers who perform services in Colorado paid wages?

Yes

No

N/A

 

NOTE: Taxable wages include payments to corporate officers and "dividends" paid in lieu of

 

 

 

 

wages to an officer who performs services for an S corporation.

 

 

 

4.If the taxpayer is an individual (sole proprietorship), does he/she have any employees other

than the individual, his or her spouse, and his or her children under the age of 21?

Yes

No N/A

5.If the taxpayer is a partnership or any type of limited liability organization, does it have anyone

 

performing services other than the partners or members of the limited liability organization?

Yes

No

N/A

6.

Did the taxpayer acquire the business in whole or in part?

Yes

No

N/A

 

If Yes, complete Form UITL-67, Business Acquisition Questionnaire.

 

 

 

7.

Has the taxpayer ever paid or expect to pay wages in the state of Colorado?

Yes

No

N/A

 

If the answer is No, do not complete the remainder of section G. BE SURE TO SIGN IN SECTION F.

 

 

 

 

If Yes, on what date?

 

 

 

 

 

 

 

 

 

 

8a.

Employers are required to provide unemployment insurance coverage if they meet the following requirements.

 

 

 

 

Please check the appropriate box and complete 8b.

 

 

 

Business Employer.

A commercial, industrial, or professional organization that pays one or more workers a total of $1,500 gross wages in a calendar quarter (Jan.-Mar., April-June, July-Sept., Oct.-Dec.) or employs one or more workers in each of any 20 different calendar weeks in a calendar year.

Agricultural Workers.

An agricultural employer who pays one or more employees a total of $20,000 gross wages in a calendar quarter (Jan.- Mar., April-June, July-Sept., Oct.-Dec.) or has ten or more employees in each of any 20 calendar weeks in a calendar year.

Household/Domestic Workers.

A household/domestic employer who pays one or more employees a total of $1,000 gross wages in a calendar quarter (Jan.-Mar., April-June, July-Sept., Oct.-Dec.).

501(c)(3) Nonprofit Organization.

A 501(c)(3) nonprofit organization that has four or more employees performing services in the United States in each of 20 weeks in a calendar year.

8b. Enter date the taxpayer did or will meet the above requirement

 

Enter total gross wages paid in the most recently completed calendar quarter

$

Enter current number of employees

 

 

 

1.Check the description that best describes the taxpayer's business activity in Colorado and explain In detail in box 2 below.

INFORMATION (303) 318-8850

Agricultural (List Crops, Animals, & Services Provided) Mining (List Product Extracted or Service Performed) Utilities (List Type and Explain Services Performed) Construction (Explain in Detail in Box 2 Below)

Construction of Buildings (List Type of Building) Heavy and Civil Engineering (Explain Below)

Subcontractor (List Specialty Trade Below and Whether Residential or Commercial Services)

Manufacturing & Assembly (List Products & Materials Used) Wholesale Trade (List What Sold and to Whom)

Retail Trade (List What Sold and to Whom) Transportation and Warehousing (List Type & Details) Information (Publish, Broadcast, Telecomm, ISPs)(Explain)

Finance & Insurance (Explain in Detail)

Real Estate and Rental and Leasing (Explain in Detail) Professional and Technical Services (Explain in Detail) Management of Companies & Enterprises (Explain)

Administrative and Waste Services (Explain in Detail) Educational Services (Explain in Detail)

Health care and Social Assistance (Explain in Detail) Arts, Entertainment and Recreation (Explain in Detail) Accommodation and Food Services (Explain in Detail)

Restaurants (Full Service-Wait People Or Limited Service) Other Services, except Public Admin. (Explain in Detail) Public Administration (Explain in Detail)

Household/Domestic

H – LABOR MARKET

2. List SPECIFIC products or services and EXPLAIN IN DETAIL. If more than one activity, make ONE a PREDOMINANT percent. (e.g. 51-49%)

3.Worksite Information - Complete the following for each physical location in COLORADO. For each additional location, copy Section H and complete. NOTE: If the employee works from home, list the resident address.

Worksite Physical Address (COLORADO BUSINESS OR RESIDENCE ADDRESS) (Do NOT list P.O. Box or accountant address)

Street

City

State

ZIP CODE

County

 

 

 

 

 

Average Number of Monthly Employees

Worksite Phone

Worksite Contact Person - Please Print

 

 

 

 

 

RETURN BOTH WHITE COPIES OF THE FORM TO COLORADO DEPARTMENT OF REVENUE.

DID YOU COMPLETE SIDE B OF COPY 1?

FEE SCHEDULE

Trade name registration: Trade name registrations after May 30th, 2006 must be done with the Colorado Secretary of State.

Wholesale, retail and charitable license

If first day of sales is:

 

January to June even–numbered years 2004, 2006, 2008

$16.00

July to December even–numbered years 2004, 2006, 2008

$12.00

January to June odd–numbered years 2005, 2007, 2009

$8.00

July to December odd–numbered years 2005, 2007, 2009

$4.00

• Charitable license

$8.00

• A deposit is required on a retail sales tax license only

$50.00

FEE NOTES

If your check is rejected due to insufficient or uncollected funds, the Department of Revenue may collect the payment amount directly from your banking account electronically.

The deposit will be refunded automatically after a business has collected and paid $50 in STATE SALES TAXES.DONOTdeduct the deposit on your sales tax return. The deposit is only required on a business first location.

There is no charge for a multiple or single event license IF a business has a current wholesale or retail sales tax license.

For single and multi event licenses complete the DR 0589 "Sales Tax Special Event Application."

All licenses except the single event license are valid through December 31 of each odd–numbered year.

If you have questions regarding “Side A” call the Department of Revenue, (303) 238-SERV(7378). If you have questions regarding “Side B”, call the Department of Labor and Employment 303-318-9100 (Denver-metro area) 1-800- 480-8299 (outside Denver-metro area).

INSTRUCTIONS: This form consists of three copies; please complete the form, mail two copies of the completed form to the Colorado

Department of Revenue, Denver, CO

80261-0013, and retain one copy for your records.

If you've downloaded this form from the Internet, please complete the form and make two photocopies of it. Mail the original form and one copy to the Colorado Department of Revenue, Denver CO 80261-0013; retain one photocopy of the completed form for your records.

For walk-in service, please bring all 3 copies of the completed form to:

DENVER SERVICE CENTER

 

1375 Sherman St.

GRAND JUNCTION SERVICE CENTER

Denver CO 80261

222 S. Sixth St., Room 208

COLORADO SPRINGS SERVICE CENTER

Grand Junction CO 81501

 

4420 Austin Bluffs Pky.

PUEBLO SERVICE CENTER

Colorado Springs CO 80918

310 E. Abriendo Ave., Suite A4

FORT COLLINS REGIONAL SERVICE CENTER Pueblo CO 81004-4226 1121 W. Prospect Rd., Bldg. D

Fort Collins, CO 80526

Taxpayer ID Requirements:

All walk-in and mail-in business and individual applicants for a Business Registration, (sales/ use tax or wage withholding) with the Colorado Department of Revenue must provide valid proof of identification at the time of application. Valid proof includes a legible copy of a Colorado Driver's License, Colorado Identification Card, United States Passport, Resident Alien Card (Indicating eligibility for employment), United State Naturalization papers, and/or Military Identification Card. If the applicant is from another state, a valid driver's license or other picture ID from that state is required.

UNEMPLOYMENT INSURANCE

Any unemployment insurance payments should be made on a separate check, payable to Colorado State Treasurer.

Questions regarding unemployment insurance may be directed to:

Colorado Department of Labor and Employment Unemployment Insurance Operations

P.O. Box 8789, Denver, CO 80201-8789 303-318-9100 (Denver-metro area)

1-800-480-8299 (outside Denver-metro area)

Visit Our Online Services: WWW.COWORKFORCE.COM/UIT/

Visit the Colorado Department of Labor and Employment online eServices. From this site, eligible employers are able to perform some functions online:

Register for an Unemployment Insurance Tax Account.

File UI Tax Report for the Current Quarter.

Submit UI Reports of Workers Wages.

Change the UI Employer Business Address

LABOR MARKET INFORMATION

If you have any questions regarding Labor Market Information, please contact:

Colorado Department of Labor and Employment

Labor Market Information

633 17th St., Suite 600

Denver, CO 80202-3660

(303) 318-8850

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Payroll Records Location List, b Address Residence or PO Box, and Payroll Records Telephone of col dept of revenue cr 0100

3. The following part focuses on Both White Pages Must Be Returned, Title Date, OFFICE USE ONLY, Account Type, NAICS, Sig, SEE PAGE FOR RETURN CHECK POLICY, Org, Date, Tech Sig, and E R U T A N G S - fill out each one of these empty form fields.

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e e r f  l l, E C N A R U S N, and SIDE B in col dept of revenue cr 0100

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