Form St 900 - Application For An Ohio Direct Payment Permit (Page 2 of 2) in pdf

Form St 900 - Application For An Ohio Direct Payment Permit Page 2

APPLICATION FOR AN OHIO DIRECT PAYMENT PERMIT

Business description:

NAICS Code

Estimated annual amount and number of taxable purchases:

$ Amount

# of transactions

Number of plants, divisions or other facilities to be included under this application :

(1) Name

(2) Name

Address

10If more than two, attach a separate sheet listing the information for the remaining locations and check box

Number of plants, divisions or other facilities in Ohio not to be included under this application:

(1) Name

(2) Name

Address

Direct Payment #

Consumers Use Tax #

None

1 If more than two, attach a separate sheet listing the information for the remaining locations and check box

I HEREBY ACKNOWLEDGE THESE RESPONSIBILITIES AND DECLARE THE INFORMATION PROVIDED ABOVE TO BE

TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF.

Signed

Title

Date

Phone Number

(

)

MAIL APPLICATION TO:

OR FAX APPLICATION TO

State of Ohio - Department of Taxation

State of Ohio-Department of Taxation

Attention: Audit Review

Audit Division

P.O. Box 530

(614) 466-1082

Columbus, Ohio 43216-0530

Page 2 of 2

Form St 900 - Application For An Ohio Direct Payment Permit Page 2