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0 <br />• <br />R <br />FILE COPTForm TA-1Application for Original Registration <br />Check As Many As Apply <br />1. A 1 _ ❑ Employer under the Income Tax Withholding Law (payroll tax) <br />2. ❑ Withholding for Pension Plans, Annuities and Retirement <br />Distributions <br />B 1. ❑ Sales,'Use Tax an Goods Vendor <br />2. ❑ Sales/Use Tax on Telecommunications Services Vendor <br />3- ❑ Meals Tax on Food and All Beverages <br />4. ❑ Purchasing in MSA for Out -of -State Resale Only <br />C ❑ Room Occupancy Excise <br />2. i`<feral Idenafcat!on number <br />0 315�13J_48a5 <br />Principal Place of Business <br />5. Owner, parcnersf.ip o^Iegat wrporae name <br />Nance (tomo.) <br />6. rdumoer and street (PO box Is not <br />qlo I f I iVIA11 � <br />7. . Cfy or toxn <br />10. <br />Rev. 5/99 <br />Massachusetts <br />ueparmi 01 <br />Revenue <br />D )Q Governmental or Charitable Exempt Purchaser <br />E ❑ Chapter 180 Organization Selling Alcoholic Beverages <br />F ❑ Use Tax Purchaser <br />G ❑ Baston Sightseeing Tour Surcharge <br />H ❑ Boston Vehicular Rental Transaction Surcharge <br />I ❑ Parking Facilities Surcharge in Boston, Springfield <br />and/or Worcester <br />J ❑ Cigar and Smoking Tobacco Excise <br />3. Social Security number 4. No. of location< <br />I I I I I I I 1 10 1 01 0 <br />LILI! IS <br />V INJA I IC <br />General Information. If a corporation, trust, association, <br />S. State 9. Zip <br />� lall.l�f I -I I I I <br />or partnership — you must complete Schedule TA -3. <br />11. Indicate type of organization: <br />X Corporation ❑ Trust or association ❑ Sole proprietor Ll Fiduciary ❑Partnership ❑ Other (specify): <br />12. Indicate type of business: <br />[J Retail trade ❑ Wholesale trade ❑Manufacturing El Construction ❑ Governmental ❑Finance 11 Real estate El Service <br />)Qo her (specify). A1oT- it p , pp, { `f 13. Desciibe nelure of business. <br />14. Business activity code 15. Check applicable box: ❑ Profit ANon-profit <br />16. If subsidiary corporation <br />17. If sole proprietor <br />(sole owner) <br />Name of parent corporation <br />Federal Identification number <br />Name of rnvner <br />Social Security number <br />I e. Reason for applying: 11, - <br />❑ Started new business ❑ Purchased existing business— enter dame, address, and Federal federal Identification number <br />Identification number of previous owner <br />71 Organizational charge — Federal Identification number and close date of previous organization must be <br />entered, or application will be returned. ❑Other (attach explanation) <br />Mo Day Yr <br />Background Information close date: <br />19. Are any Massachusetts tax returns due or any Massachusetts taxes owed by your firm? ❑ Yes�%No. If yes, please explain: <br />20. Have you ever been issued a Certificate of Registration that was later revoked? ❑ Yes XNo. If yes, please explain: <br />Exempt Organizations <br />21. If you are applying for exempt purchaser statusbe sure to include a copy of your IRS letter of exemption under Section 501(c)(3) of the Internal <br />Revenue Code. Subordinate organizations covered under an IRS group exemption letter should include a copy of the group exemption ruling and <br />a copy of the organizations directory page listing the organization as an approved subordinate. Both of the questions below must be answered. <br />• A. Are you exempt from paying U.S. income laxesp %Yes ❑ No. B. Are you exempt from paying local property taxes? XI Yes ❑ No. <br />FILE COPY <br />