Solid Waste Disposal Fee Registration Form - Alabama Department Of Revenue
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1TOB: SWST-REG
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LABAMA
EPARTMENT OF
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USINESS
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P.O. Box 327556 • Montgomery, AL 36132-7556 • (334) 353-7827
Solid Waste Disposal Fee Registration Form
THIS FORM MUST BE COMPLETED BY SOLID WASTE MANAGEMENT FACILITIES WHO HAVE BEEN ISSUED A PERMIT BY THE
ALABAMA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT (ADEM)
FILL IN THE BLANK AREAS. RETURN FORM TO ABOVE ADDRESS.
COMPANY NAME
ADDRESS
CITY
STATE
COUNTY
ZIP
CONTACT PERSON
TITLE
E-MAIL ADDRESS
PERMIT NUMBER (ASSIGNED BY ADEM)
PERMIT TYPE
FEIN
SSN
TELEPHONE NUMBER
–
OR
(
)
Type of Business Entity:
Individually owned
Partnership
Corporation
Limited Liability Co. (LLC)
Other ____________________
List the names, identifying number (social security or FEIN number), and address of all owners, partners, corporate officers, and LLC
members. Attach additional sheets if space is not sufficient.
NAME
SSN/FEIN (Identifying #)
TITLE
HOME ADDRESS
If you are a LLC, are you a
Single-member or
Multi-member
For Federal income tax purposes, have you filed Internal Revenue Service (IRS) form 8832 electing to be treated as a corporation?
Yes
No
If yes, please attach a copy to this form.
_____________________________________________________
______________________________ _____________________
SIGNATURE OF OWNER, PARTNER, CORPORATE OFFICER OR LLC MEMBER
TITLE
DATE
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