Indiana Otp 901 Form PDF Details

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!

QuestionAnswer
Form NameIndiana Otp 901 Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesotp901 indiana otp 901 renewal form

Form Preview Example

INDIANA DEPARTMENT OF REVENUE

OTP-901

R3/ 10-07

P.O. BOX 901

INDIANAPOLIS, IN 46206-0901

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

 

 

Renewal

 

 

 

 

New Certificate

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Applicant’s Name - Enter individual’s, partnership’s, or corporation’s name

 

 

 

 

 

 

Federal ID Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Business/Trade Name (if different than above)

 

 

 

Telephone Number

 

 

 

Owner’s Social Security #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing Address (Street or P.O. Box Number)

 

 

 

City or Town

County

 

 

State

Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Location Address of Business (if different than above)

 

 

 

City or Town

County

 

 

State

Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Type of Ownership:

 

Sole Proprietorship

 

 

Partnership

 

Corporation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

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