Form Preview Example

Form TA-1

Application for Original Registration

Rev. 12/02

Massachusetts

Department of

Revenue

Check As Many As Apply

1. A	1.	Employer under the Income Tax Withholding Law (payroll tax)	D	Governmental or Charitable Exempt Purchaser

	2.	Withholding for Pension Plans, Annuities and Retirement	E	Chapter 180 Organization Selling Alcoholic Beverages

		Distributions	F	Use Tax Purchaser


B	1.	Sales/Use Tax on Goods Vendor	G	Boston Sightseeing Tour Surcharge


	2.	Sales/Use Tax on Telecommunications Services Vendor	H	Boston Vehicular Rental Transaction Surcharge


	3.	Meals Tax on Food and All Beverages	I	Parking Facilities Surcharge in Boston, Springfield


	4.	Purchasing in MA for Out-of-State Resale Only		and/or Worcester


C		Room Occupancy Excise	J	Cigar and Smoking Tobacco Excise

Note: If you are selling cigarettes at retail, see instructions.

Federal Identification number

Social Security number

No. of locations

Principal Place of Business

10.

Owner, partnership or legal corporate name

Name (cont’d.)

Number and street

City or town

(Area code) Telephone number

(

)

—

State

Zip

—

General Information. If a corporation, trust, association, fiduciary, or partnership — you must complete Schedule TA-3.

11.Indicate type of organization:

Corporation Trust or association Sole proprietor Fiduciary Partnership Other (specify):

12.Indicate type of business:

Retail trade

Wholesale trade

Manufacturing

Construction

Governmental

Finance

Real estate

Service

Other (specify):

13. Describe nature of business:

14.

Business activity code

15. Check applicable box:

Profit

Non-profit

16.

If subsidiary corporation

Name of parent corporation

Federal Identification number

❿

17.

If sole proprietor

Name of owner

Social Security number

(sole owner)

❿

18. Reason for applying:

Started new business

Purchased existing business — enter name, address, and Federal

Federal Identification number

Identification number of previous owner

Federal Identification number

Organizational change — Federal Identification number and close date of previous organization must be

entered, or application will be returned.

Other (attach explanation)

Day

Background Information

Close date:

19.Are any Massachusetts tax returns due or any Massachusetts taxes owed by your firm? Yes No. If yes, please explain:

20.Have you ever been issued a Certificate of Registration that was later revoked? Yes No. If yes, please explain:

Exempt Organizations

21.If you are applying for exempt purchaser status, be sure to include a copy of your IRS letter of exemption under Section 501(c)(3) of the Internal Revenue Code. Subordinate organizations covered under an IRS group exemption letter should include a copy of the group exemption ruling and a copy of the organization’s directory page listing the organization as an approved subordinate. Both of the questions below must be answered.

A. Are you exempt from paying U.S. income taxes? Yes No. B. Are you exempt from paying local property taxes? Yes No.

Location of business	Federal Identification number

22.Trade name

Trade name (cont’d.)

23.Number and street (PO box is not acceptable)

24.	City or town						25.	State	26.		Zip
												—
												—
27.	(Area code) Telephone number			28.	Send certificate to:	Principal place of business				Location of business.
27.	(Area code) Telephone number			28.	Send certificate to:	Principal place of business				Location of business.

	(	)	—	29.	Send tax forms to:	Principal place of business				Location of business			Other.

If “Other,” complete Schedule TA-4.

Convention Center Financing District

30.Check here if your business location is within a Convention Center Financing District: (see pages 24–26 of instructions).

31.Check here if your business location is within a hotel, motel or other lodging establishment in Boston or Cambridge:

Filing Frequencies

32.

Is this location seasonal? (See instructions)

Yes

No.

33. Indicate 12-month estimate of tax to be withheld, collected or

If “yes,” check month(s) or partial month(s) business operates.

paid for each applicable tax. Check the appropriate box(es).

Check month(s)

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Check appropriate box

$0 – $100

$101– $1,200

$1,201–$25,000

over $25,000

Withholding

Sales/Use on Goods

Check appropriate box(es)

$0 – $100

$101– $1,200

over $1,200

Sales/Use on

Sales/Use on Goods

Telecom. Services

Sales/Use on Telecom. Services

Meals

Room Occupancy

Use Tax Purchaser

Tax Type Information

Withholding

34.

Date you were first required to withhold

Day

35. Number of employees

taxes at this location.

in Massachusetts:

Sales/Use Tax on Goods

36.

Date you were first required to collect sales/use tax at this location.

Day

Sales/Use Tax on Telecommunications Services

37.

Date you were first required to collect sales/use tax on telecommunications services at this location.

Day

Meals Tax on Food and All Beverages

38.

Check if you serve:

Food

Beer

Wine

Alc. bev.

39. Check if food/beverage vending machine:

40.

Date you were first required to collect meals tax.

Day

41. Name and address

on liquor license42. Seating capacity: at this location.

Room Occupancy

43.

Date you were first required to collect room occupancy tax.

Day

44.

Locality code

45.

Number of rooms:

Use Tax Purchaser

46.

Date you were first required to pay use tax.

Day

Convention Center Financing Surcharges

47.

Date you were first required to collect: a. Boston Sightseeing Tour Surcharge.

Day

b. Boston Vehicular Rental Transaction Surcharge.

Day

c. Parking Facilities Surcharge in Boston, Springfield and/or Worcester.

Day

Cigar and Smoking Tobacco Excise

48. Date you were first required to collect cigar and smoking tobacco excise.	Mo	Day	Yr

Mail to: Massachusetts Department of Revenue, Data Integration Bureau, PO Box 7022, Boston, MA 02204.

I hereby certify that the statements made herein have been examined by me and are, to the best of my knowledge and belief, true and correct. Signed under the pains and penalties of perjury. The signing of this application is evidence that you may be individually and personally responsible for any sums required to be paid to the Commonwealth, under MGL, Chapters 62B, Sec. 5; 64G, Sec. 7B; 64H, Sec. 16 and 64I, Sec. 17.

Your signature

Title

Date

Question	Answer
Form Name	Massachusetts Form Ta 1
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	massachusetts form ta, print fprm 1 es ma, ta 1 form printable, ma ta 1

Massachusetts Form Ta 1 – Fill Out and Use This PDF

Massachusetts Form Ta 1 PDF Details

Form Preview Example

Massachusetts Form Ta 1 isn’t the one you’re looking for?

Massachusetts Form Ta 1 – Fill Out and Use This PDF

Massachusetts Form Ta 1 PDF Details

Form Preview Example

Massachusetts Form Ta 1 isn’t the one you’re looking for?

Related Documents