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APPLICATION FOR AUTHORITY
STATE OF CONNECTICUT
TO COLLECT CONNECTICUT
DEPARTMENT OF REVENUE SERVICES
USE TAX
25 Sigourney Street, Hartford CT 06106
DO NOT WRITE IN THIS BLOCK
TAX REGISTRATION NUMBER
REG-7
(New 6/89)
IMPORTANT!
READ INSTRUCTIONS
BELOW
DRS USE ONLY
TAX REG
TR
AD
1 . LEGAL NAME OF BUSINESS (OWNER’S NAME, PARTNERS’ NAMES, OR CORPORATE NAME)
2. FEDERAL EMPLOYER I.D. NUMBER
00
3 . TRADE OR REGISTERED NAME OF BUSINESS IF DIFFERENT FROM ITEM 1 ABOVE
00
4 . PHYSICAL LOCATION OF THIS BUSINESS
(P.O. Box is not acceptable)
(ZIP + 4)
PHONE NUMBER
00
5 . BUSINESS MAIL ADDRESS IF DIFFERENT FROM ITEM 4 ABOVE
(ZIP + 4)
00
6a. NAME AND HOME ADDRESS OF OWNER, PARTNER OR CORPORATE OFFICER
(ZIP + 4)
00
6b. NAME AND HOME ADDRESS OF PARTNER OR OFFICER
(ZIP + 4)
00
6c. NAME AND HOME ADDRESS OF PARTNER OR OFFICER
(ZIP + 4)
00
7 . TYPE OF ORGANIZATION:
CORPORATION
S CORPORATION
INDIVIDUAL
PARTNERSHIP
OTHER (Explain)
8 . DATE THIS BUSINESS STARTED MAKING
M
D
Y
9 . IF A CORPORATION, GIVE STATE OF INCORPORATION
SALES INTO CONNECTICUT
10. DESCRIBE IN DETAIL THE TYPE OF BUSINESS YOU OPERATE
11. SIGNED:
TITLE:
DATE:
TAX
R E C
T R A N S
REGISTRATION DATE
SIC CODE
TYPE ORG STATE
LEGAL DATE
AMOUNT SUBMITTED
DRS USE ONLY
00
10
2
/
/
/
/
0
LEVEL 2
TAX TYPE
REC TYPE
TRANS
REGISTER DATE
START DATE
BUS TOWN
SRCE
LIAB. CODE
11
10
2
/
/
/
/
170
01
5
LEVEL 6
FIL CODE
TYPE FIL
MAIL CODE
SECURITY NUMBER
SECURITY DATE
SECURITY AMOUNT
FEE REMITTED
1130
1
1
/
/
0
INSTRUCTIONS
1. Indicate the exact legal name of business for which this application is being completed. If sole proprietorship or partnership, indicate
legal name or names of owners.
2. Indicate the Federal Employer Identification Number assigned to this business. Sole proprietors not assigned a Federal Employer
Identification Number may indicate the sole proprietor’s Social Security Number.
3. Indicate the trade name of this business if different from Item 1. If not different, indicate “same as above”.
4. Indicate the physical location of this business (number and street address, city, state and zip code) and phone number. Do not
indicate a post office box number.
5. Indicate a business mailing address if different from Item 5. If not different, indicate “same as above”.
6. Indicate the name and home address of the owner or each partner or each corporate officer. Attach a list if more space is needed.
7. Check the appropriate box.
8. Indicate the date on which this business started to make sales into Connecticut.
9. If this business is incorporated, indicate the State under the laws of which it is incorporated.
10. Describe fully the activities of this business, particularly its sales activities connected with Connecticut.
11. This application must be signed by an owner, partner or corporate officer.