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Form Sn-1 - West Virginia Application For Sparklers And Novelties Registration Certificate

SN-1

West Virginia

West Virginia Application For

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State Tax

Sparklers and Novelties Registration Certificate

Department

REV 02-12

1. West Virginia Taxpayer Identification Number*:

*If you have a Federal Employers Identification Number, enter it. (All partnerships and sole-owners with employees must have a

FEIN). If sole-owner, enter social security number.

2. Business Name and Actual Physical Location*

3. Mailing Address (Where certificates are to be sent)

Legal Business or Corporate Name

Name

DBA Division or Subsidiary Name

Additional Space for Name (if needed)

Owner’s Name (if Sole Owner)

Address (Street) DO NOT USE PO BOX NUMBER

Address (Street or PO Box)

City

Zip Code

State

*PAGE TWO OF APPLICATION MUST BE COMPLETED IF FILING AN APPLICATION FOR A BUSINESS THAT HAS MORE THAN ONE PHYSICAL

LOCATION IN WEST VIRGINIA FROM WHICH SPARKLERS AND NOVELTIES WILL BE SOLD.

4. Do you have a current West Virginia Business registration certificate for the physical location in this state from which you intend to sell sparklers and

novelties?

Yes

If yes, enter your account identification number and business name as it appears on your business registration certificate. IF MORE THAN ONE

PHYSICAL LOCATION, SEE PAGE TWO.

_______________________________________________________________

Business Name

Account Number

IF A LOCATION DOES NOT HAVE A CURRENT BUSINESS REGISTRATION CERTIFICATE, APPLICANT WILL NEED TO FILE AN “APPLICATION

FOR REGISTRATION CERTIFICATE”, (FORM WV/BUS-APP).

Fee Computation:

.00

Number of business locations registered

X $15.00

.00

Total Sparkler & Novelties Registration Fees Due.......................................

MAKE REMITTANCE PAYABLE TO THE WEST VIRGINIA STATE TAX DEPARTMENT

PLEASE RETAIN A COPY OF THIS REGISTRATION APPLICATION FOR YOUR RECORDS

A SPARKLER AND NOVELTIES REGISTRATION CERTIFICATE ONLY AUTHORIZES THE HOLDER TO SELL SPARKLERS AND NOVELTIES AS

DEFINED IN WV CODE § 29-3-23 (AS AMENDED BY S.B. 482, 1995). THIS CERTIFICATE DOES NOT AUTHORIZE THE VENDOR TO SELL ANY

FIREWORKS THAT MAY NOT BE LAWFULLY SOLD IN WEST VIRGINIA.

Signature

Title

Date

Mail Completed Application to:

West Virginia State Tax Department

Revenue Division

P.O. Box 2666

Charleston, WV 25330-2666

*b46201201W*

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Form Sn-1 - West Virginia Application For Sparklers And Novelties Registration Certificate

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