Form Reg-8 - Application For Farmer Tax Exemption Permit - State Of Connecticut
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1STATE OF CONNECTICUT
APPLICATION FOR FARMER
DEPARTMENT OF REVENUE SERVICES
TAX EXEMPTION PERMIT
FOR DEPARTMENT USE ONLY
Taxpayer Services Division
Permit Number
25 Sigourney Street, Hartford, CT 06106-5032
REG-8 (Rev. 07/98)
IMPORTANT - Read Instructions on Reverse Side
Approved
Denied
TPS #
Before Completing This Form
1999 FARMER TAX EXEMPTION PERMITS WILL BE VALID
FROM OCTOBER 1, 1998, OR SUBSEQUENT DATE OF ISSUANCE, UNTIL SEPTEMBER 30, 1999.
(Individual)
SOCIAL SECURITY NUMBER
Please correct
Name and
(Other)
FEDERAL EMPLOYER I.D. NUMBER
Address
if shown
incorrectly
CHECK ONE:
CHECK ONE:
at right
New
Individual
Partnership
Name of Farm
Telephone Number
Renewal
Corporation
LLC
Name
Location of Farm
LLP
Change
Fiduciary
1. Was the applicant engaged in agricultural production as a trade or
2. Applicant:
owns the farmland
leases the farmland
business during 1997?
Yes
No
(Check one)
owns part and leases part of the farmland
3. Total acreage of farm:
Total acres used in agricultural production by applicant during 1997:
4. What farm products, including livestock, did applicant
5. What farm products, including livestock, will applicant
raise during 1997?
raise during 1998?
6. Has the applicant been issued a Sales and Use Tax permit by the
Department of Revenue Services?
Yes
No
7. Does the applicant have employees?
Yes
No
8. If yes to 6 or 7, enter 10-digit Connecticut Tax Registration Number.
(Do not enter Farmer Tax Exemption Permit Number or Federal Employer Identification Number.)
- 0 0 0
9. State the amount of gross income derived solely from agricultural production as reported
on the applicant’s 1997 federal income tax return. (See instructions.)
$
10. If the amount entered on Line 9 is less than $2,500 but the applicant qualifies because the applicant purchased an existing agricultural business
in 1997 or 1998 enter the following information. (See instructions.)
Name of Seller
Seller’s Farmer Tax Exemption Permit Number
Important: All applicants must submit the specified pages of their most recently filed
federal income tax return and the federal Schedule C or Schedule F.
Please refer to General Instructions on the reverse.
SIGN THIS AFFIDAVIT ONLY BEFORE A NOTARY PUBLIC, JUSTICE OF THE PEACE OR COMMISSIONER OF THE SUPERIOR COURT.
I,
, being duly sworn, depose and say:
I am over eighteen years of age and understand the obligation of oath. If the aforementioned applicant is a corporation, limited liability
company, partnership or fiduciary of a trust or estate, I have the authority to execute this affidavit, and am executing this affidavit on behalf
of the applicant. I have examined this application and to the best of my knowledge and belief it is true, complete and correct.
Signature of Applicant(s). Husband and wife must both sign if a joint application is filed (See General Instructions).
STATE OF
ss.
COUNTY OF
On this the
day of
, 19
, before me, the undersigned officer, personally appeared
, known to me (or satisfactorily proven) to be the person whose name is subscribed to
the within instrument and acknowledged that
executed the same for the purposes therein contined. In witness whereof, I
hereunto set my hand.
Signature of officer taking acknowledgment
Title of officer taking acknowledgment
My commission expires on the
day
(Notary Public: Affix seal here)
of
, 19
.
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