If you're a business owner in Indiana, there's a good chance that you have encountered the Indiana OTP 901 Form. This form is required if your business needs to pay individuals or corporations for services rendered, and understanding exactly what it is and how to fill it out can be confusing. In this helpful guide we'll explain why the OTP 901 Form is so important, when businesses may need to use it, and provide step-by-step instructions on how to accurately submit the form itself. Make sure to keep reading if you're looking for more information on the Indiana OTP 901 Form!
Question | Answer |
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Form Name | Indiana Otp 901 Form |
Form Length | 2 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 30 sec |
Other names | otp901 indiana otp 901 renewal form |
INDIANA DEPARTMENT OF REVENUE
R3/
P.O. BOX 901
INDIANAPOLIS, IN
This form must be submitted 30 days prior to:
a)the expiration of your current license or,
b)the date you begin your business
You may not do business without your certificate.
FOR OFFICE ONLY
OTP
APPLICATION FOR OTHER TOBACCO PRODUCTS DISTRIBUTOR’S LICENSE
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Renewal |
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New Certificate |
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Applicant’s Name - Enter individual’s, partnership’s, or corporation’s name |
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Federal ID Number |
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Business/Trade Name (if different than above) |
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Telephone Number |
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Owner’s Social Security # |
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Mailing Address (Street or P.O. Box Number) |
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City or Town |
County |
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State |
Zip Code |
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Location Address of Business (if different than above) |
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City or Town |
County |
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State |
Zip Code |
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Type of Ownership: |
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Sole Proprietorship |
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Partnership |
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Corporation |
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If Corporation: Date of Incorporation:___________________________________
If Foreign Corporation: Date of Acceptance by Indiana Secretary of State:______________________________________________
If an Indiana corporation or a foreign corporation, give name and address of Resident Agent:________________________________
Identifi cation of Partners or Corporate Officers
Name (last name fi rst)
Social Security Number
Address
City
State |
Zip Code |
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Title
Reason License Needed (Answer Yes or No):
New Business: |
Purchase of Existing Business: |
Lease of Existing Business: |
From Whom Was Business Purchased or Leased?
Reinstatement of Old License:
Does Applicant Presently Hold a Cigarette Tax License? ________________ License Number:___________________________
Has Applicant Previously Held a Cigarette Tax License? ________________ License Number:___________________________
Does Applicant Presently Hold an Indiana Registered Retail Merchants Certifi cate? _________ Certificate Number:_______________________________
Does Applicant Presently Hold Any Other Licenses or Permits Issued by any State Agency?
STATE AGENCY
TYPE OF LICENSE OR PERMIT
NUMBER
Audit Information:
Location Where Records Will Be Available For Audit:
Phone Number of Location Of Audit Records:
Phone Number of Business Location:
Indicate Address of Each Location In Which You Have Other Tobacco Products in Storage
Location
OTP License Number
Indicate Name, Address, Phone Number and Estimated Annual Purchases from Whom You Currently Purchase and/or Expect to Purchase Other Tobacco Products: (A Computer Generated List Which Includes All Requested Information Will Be Accepted)
Supplier’s Name
Address
Phone Number
Estimated Annual Purchases
TOTAL:
If Necessary Attach Additional List.
Does Your Company Expect to Sell Other Tobacco Products Into Another State?___________________________________________________________________
List States: _________________________________________________________________________________________________________________________
Today’s Date
I declare under penalties of perjury that the information contained in this application and any attachments is true, correct and complete to the best of my knowledge and belief.
Signature of Taxpayer or Authorized Agent, Title |
Telephone Number |