21955 - Application To Register For Sales & Use Tax Permit As A Sole Proprietor Form
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1North Dakota Office of State Tax Commissioner
Application to Register for Sales &
Use Tax Permit as a Sole Proprietor
For Office Use Only
S/U _________________________
_________________________
Before you begin to complete this application, please answer the following questions:
1. Do you have employees for which you have a withholding obligation?
2. Are you making sales on a regular, ongoing basis (store front operation, home based business,
internet sales)?
3. Is your business ownership type anything other than a sole proprietorship (individual owner)?
If you answered yes to any of these questions or if you have a business location other than your home
address, please do not use this application form. Use the Application to Register For Income Tax
Withholding and Sales and Use Tax Permit available on our web site at
1. Owner's Name
2. Phone Number
3. Business Trade Name/Doing Business As (DBA), if applicable
4. Owner's Social Security Number
5. Address
City
State
Zip Code
6. Business Activity: List the principal products or activities of your business: i.e. crafts, concessions, candy.
/
/
7. Beginning date of sales made in North Dakota:
MM
DD
YYYY
8. Please check the months in which you will be making your sales:
January
May
September
February
June
October
March
July
November
April
August
December
9. Application must be signed by owner.
Date
Signature
I declare under the penalties of North Dakota Century Code ch. 12.1-11-02, which provides for a Class A
misdemeanor for making a false statement in a governmental matter, that this application has been examined
by me and to the best of my knowledge and belief is a true, correct, and complete application.
For Office Use Only
Mail to: Office of State Tax Commissioner
Contact: Fax: (701)328-0336
Business Registration
Phone: (701)328-3474 - Sales
600 E. Boulevard Ave., Dept. 127
Web site:
Bismarck, ND 58505-0599
21955
(Revised 11-05)
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