City Solid Waste Sales Tax Permit

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i t 15 . What's the dollar value of your inventory? 16 17. What's the dollar value of your fixtures and erniinment? Date you will begin your business? QuS a mm/dd/yyyy M 18. Check type of business: Retail Wholesale CHECK TYPE OF BUSINESS ENTITY: 19. Corporation 7 S Corporation = Individual Partnership LLC = LLP = Government 20. Date Arkansas Incorporated? I S— W `j 1 mm/dd/yyyy 21. Please check one: Inside city limits � Outside city limits 22. Does this business sell or serve beer? wine? KO liquor? tZ mixed drinks?LX— Private Club? N If YES, please furnish the ABC number under which you are operating. 23. Does this business sell tobacco products? wo `/ 24. Do you operate more than one business in �kansas? y Z5 If YES, please list all locations, names, addresses and permit numbers on�separate schedule. Cr nun c PC"/ G 4 C- VS 1 ?r rr, f 4 00,:2 / 7) (o - � a -C� l '(f, 25. Did you purchase the inventory, fixtures or equipment of an established business? � If YES, give the name and permit number of the business. (attach bill of sale) Former business name Former business permit number 26. Are you leasing the property? 0-0— If YES, attach a copy of the lease agreement. 27. Do you operate a business in your home? AL If Yes, attach a copy of your city business license or furnish a statement that this license is not required. 28. If you operate an out-of-state business; do you perform any type of repair or service within the state of Arkansas? If YES, please list exactly the repair or service performed. Important Information A) A $50.00 FEE IS REQUIRED OF ALL ARKANSAS VENDORS ON A RETAIL OR WHOLESALE BASIS. Out of state vendors that lease property into Arkansas or perform taxable services in Arkansas are required to pay the $50 registration fee. Please make check payable to Department of Finance and Administration. B) The former owner of a business must surrender the permit, and report and pay all taxes due by the business through the transfer date. A lien will attach to the stock and fixtures to secure the State of Arkansas for delinquent taxes and is enforceable against purchaser. C) Arkansas Code Annotated 26-52-207 states that the tax liability of the former owner transfers to the new owner when the business is sold. No permit will be issued to the new owner until all tax liability is paid. I DECLARE UNDER PENALTY OF PERJURY, THAT THIS APPLICATION (INCLUDING ANY ACCOMPANYING SCHEDULES) HAS BEEN EXAMINED BY ME, AND TO THE BEST OF MY KNOWLEDGE AND BELIEF IS A TRUE, CORRECT AND COMPLETE AP LICATION. Original Signature of O er/Partner/Officer Printed Name of Owner/Partner/Officer Date FOR OFFICE USE ONLY - DO NOT WRITE IN THIS SPACE SALES = USE = MD = LE ACCT: BONDED: ISSUED BY: COUNTY CODE AV = TEX SIC: LOC CODE: PREVIOUS ACCT: DATE: PAID BY: cash/check/money order Form ST-f (R 07/2006)