Form Ador 10194 – Fill Out and Use This PDF

IMPORTANT: Incomplete applications WILL NOT BE PROCESSED. All required information is designated with asterisk *

To complete this application see attached instructions. Please return Complete application with appropriate license fee(s) to: License & Registration Section,

Department of Revenue, PO BOX 29032, Phoenix AZ 85038-9032.

To complete this online,

go to www.aztaxes.gov

1. License Type (Check all that apply) *

Transaction Privilege Tax (TPT)

Withholding/Unemployment Tax (if hiring employees)

Use Tax

TPT For Cities ONLY

3.Federal Employer Identification Number (Required for Employers and Entities other than Sole Proprietors) or Social Security Number *

2. Type of Ownership *
Individual / Sole Proprietorship				Sub-Chapter S Corporation
Partnership				Association
Professional Limited Liability				Trust
Limited Liability Company				Government
Limited Liability Partnership				Estate
Corporation				Joint Venture
State of Inc.				Receivership
Date of Inc.

Tax exempt organizations must attach a copy of the Internal Revenue Service letter of determination.

5. Business or “Doing Business As” Name *

6. Business Phone Number *

7. Fax Number

8. Mailing Address (Street, City, State, ZIP code) *

9. Country

10. Email Address

11. Is your business located on an Indian Reservation?

	Yes	If yes,		(See Section G for listing of Reservations)
	No

12. Physical Location of Business (Street, City, State, ZIP code) Do not use PO Box or Route No. *

13. County

14. Are you a construction contractor? *
 Yes	(See Bonding Requirements below)

 No

15. Did you acquire, or change the legal form of business of, all or part of an existing business? *
 Yes	If yes, you must complete the Unemployment Tax Information (Section D)

 No

A. Name (Last, First, MI) *

B. Soc. Sec. No. *

C. Title *

D. % Owned *

E. Complete Residence Address *

F. Phone Number *

1. Date Business Started in Arizona *

2. Date Sales Began *

3. What is your anticipated annual income for your first twelve months of business?

5.TPT Filing Method

Cash Receipts

Accrual

6. Does your business sell tobacco products?

 Yes	If yes,  Retailer
	OR
 No	 Distributor

7.Does your business sell new motor vehicle tires or

vehicles?  No

 Yes

(You will be required to file a TR-1.)

8.Are you a seasonal filer?

 Yes  No

If yes, please check the months in which you intend to do business:

Jan	Feb	Mar	Apr	May	Jun	Jul	Aug	Sep	Oct	Nov	Dec

10. Name of Company or Person to Contact

11. Phone Number

12. “Doing Business As” Name for this Location

13. Phone Number

22. City

23. County

24. State

25. ZIP code





I Elect to Register to use aztaxes.gov to file and pay online.

I DO NOT Elect to Register to use aztaxes.gov to file and pay online.

USE THIS APPLICATION TO:

•License New Business: A new business with no previous owners.

•Change Ownership: If acquiring or succeeding to all or part of an existing business or changing the legal form of your business (sole proprietorship to corporation, etc.).

If you need to update a license, add a business location, get a copy of your license or make other changes: Complete a

Transaction Privilege Tax License Update form and include fees of $12 per location.

Section A: TAXPAYER INFORMATION 1. LICENSE TYPE

Transaction Privilege Tax (TPT): Anyone involved in an activity taxable under the TPT statutes must apply for a TPT License before engaging in business.

For TPT, you are required to obtain and display a separate license certificate for each business or rental location. This may be accomplished in one of the following ways:

Each location may be licensed as a separate business with a separate license number for purposes of reporting transaction privilege and use taxes individually. Therefore a separate application is needed for each location.

Multiple locations may be licensed under a consolidated license number, provided the ownership is the same, to allow filing of a single tax return. If applying for a new license, list the various business locations as instructed below. If already licensed and you are adding locations, do not use this application to consolidate an existing license. Please submit update form.

Withholding & Unemployment Taxes: Employers paying wages or salaries to employees for services performed in the State must apply for a Withholding number & Unemployment number.

Use Tax: Out-of-state vendors (that is, vendors with no Arizona location) making direct sales into Arizona must obtain a Use Tax Registration Certificate. In-state vendors making out-of-state purchases for their own use (and not for resale) must also obtain the Use Tax Registration Certificate.

TPT for cities only: This type of license is needed if your business activity is subject to city TPT that is collected by the state, but the activity is not taxed at the state level. Many of the larger cities in Arizona administer and collect their own privilege taxes. Please contact those cities directly to obtain information regarding licensing requirements.

2.TYPE OF OWNERSHIP

Check as applicable. A corporation must provide the state and date of incorporation.

3.Enter your Federal Employer Identification number.

•Taxpayers are required to provide their taxpayer identification number (TIN) on all returns and documents. A TIN is defined as the federal employer identification number (EIN), or social security number (SSN) depending upon how income tax is reported. The EIN is required for all employers. A penalty of $5 will be assessed

by the Department of Revenue for each document filed without a TIN.

4.Enter the Legal Business Name of the Owner or Employing Unit (name of corporation as listed in its articles of incorporation, or individual & spouse, or partners, or organization owning or controlling the business).

5.Enter the name of the Business/DBA (doing business as) Name. If same as above, enter “same.”

6.Enter the business telephone number including area code.

7.Enter the fax number including area code.

8. and 9. Enter mailing address where all correspondence is to be sent. You may use your home address, corporate headquarters, or accounting firm’s address, etc. If mailing address differs for licenses (for instance withholding and unemployment insurance), please use cover letter to explain.

10.Enter the e-mail address (option) for the business or contact person.

11.See section G for listing of reservation codes if your business is located on an Indian Reservation.

12. and 13. Enter the physical location of business including county. This can not be a PO Box or Route Number.

14.If you are a construction contractor, read the bonding requirements carefully.

15.If you answered yes, you must complete Section D.

16.Describe the major business activity: principal product you manufacture, commodity sold, or services performed. Your description of the business is very important because it determines your transaction privilege tax rate and provides a basis for state economic forecasting.

17.Enter the North American Industries Classification System (NAICS) code identified for your business activity.

18.Identifytheownersofthebusiness.Enterasmanyas applicable; attach a separate sheet if additional space is needed.

Section B: TRANSACTION PRIVILEGE TAX (TPT)

1.Enter the date the business started in Arizona.

2.Enter date sales began in Arizona, or estimate when you plan to begin selling in Arizona.

3.Enter the amount of Transaction Privilege Tax income you can reasonably expect to generate in your first twelve months of business. You will be set up for monthly filing unless your anticipated annual income will result in a tax liability of less than $1,250, which may qualify you for quarterly filing.

4.For businesses applying for Transaction Privilege and/or Use Tax, enter the applicable business classes based on your activity. See Section H for listing of business classes.

JT-1/UC-001 (7/11)

5.Cash/Accrual Methods: Cash method requires the payment of tax based on sales receipts actually received during the period covered on the tax return. When filing under the accrual method, the tax is calculated on the sales billed rather than actual receipts.

6.Complete as indicated.

7.Sellers of new motor vehicles and motor vehicle tires in the state, for on-road use, are required to report and pay waste tire fees to the Department of Revenue. By checking the box, you will receive form TR-1 on a quarterly basis.

8.If your business is seasonal or a transient vendor, indicate the months in which you intend to do business.

9. 10. and 11. Indicate the physical location of your tax records, the contact person and their phone number. This can not be a PO Box or Route Number.

12. through 25. If you have additional business locations, complete this section. If more space is necessary, attach additional sheets.

Section C: PROGRAM CITIES / LICENSE FEES

There are no fees for Withholding, Unemployment, or Use Tax registrations. To calculate the fees for TPT licenses, multiply the number of locations in the state by $12. To calculate the city fees, use the listing of program cities in Section C. First, indicate the number of businesses or physical locations for each of the cities for which the Department of Revenue licenses and collects. Then multiply by the city fee for each city in which you will do business. Add the columns to determine the total city fees. Fill in the totals for state fees and city fees on the application form and total to determine the amount due. Make checks payable to the Arizona Department of Revenue. Be sure to return the city fees sheet with your application. To obtain licensing for cities not listed on the form, please contact the city directly.

Section D: WITHHOLDING/UNEMPLOYMENT TAX INFORMATION

1. through 7. Complete as indicated.

8.Enter the date you acquired the previous owner’s business or changed the legal form of your existing business (sole proprietor to corporation, etc).

9.Indicate whether you acquired or changed all or only part of the existing Arizona business. If part, to obtain an unemployment tax rate based on the business’s previous account, you must request it no later than 180 days after the date of acquisition or legal form of business change; contact the Unemployment Tax Office Experience Rating Unit for an Application & Agreement for Severable Portion Experience Rating Transfer (form UC-247; printable version available online at www.azui.com).

10. Indicate the manner in which you became the new owner or operator of this business or, if you merely changed the legal form of your existing business, check “Other” and explain, for example, “Changed sole proprietorship to corporation.”.

11. through 12. Complete as indicated if you acquired an existing business or, if you merely changed the legal form of your existing business, provide information on your business under its previous legal form.

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13. through 15. Complete as indicated if you know the previous owner’s information or, if you merely changed the legal form of your existing business, provide information on your business under its previous legal form.

16. Once certain conditions are met, the law requires employers to provide unemployment insurance coverage to their workers, but only for services the law defines as employment. Check Box A if you believe you have not met such conditions and you voluntarily elect to provide such coverage anyway. Check Box B if you voluntarily elect to cover your workers who perform services the law excludes from its definition of employment and who are excluded from coverage otherwise. Leave boxes blank if neither choice applies.

Please note: If you check one or both boxes, then your signature(s) in Section F confirm(s) your voluntary election to assume liability for the extent of unemployment coverage your selection indicates for at least two calendar years, and you will not be permitted to challenge this election at a later date if it is approved. To learn more, please refer to the Employers’ Handbook or Guide to Arizona Employment Tax Requirements available online at www.azui.com, or contact the Unemployment Tax Office Employer Status Unit.

Section E: AZTaxes.gov AUTHORIZED USER INFORMATION

1. through 6. Complete this section if you would like to designate a security administrator for your online services at www.aztaxes. gov. The authorized individual will have full access to tax account information and will add or delete users and grant user privileges to view tax account information, file tax returns, and remit tax payments on behalf of the business identified in Section A. The name and e-mail address of the administrator are required for registration.

Section F: SIGNATURES

The application must be signed only by individuals legally responsible for the business, not agents or representatives.

Section G: INDIAN RESERVATION CODES

If your business is located on an Indian Reservation, select the appropriate code from this table and indicate on Section A-11.

Section H: BUSINESS CLASSES

Select appropriate business classes based on your business activities. You must indicate at least one business class on Section B-4.