Form Ap-147-3 - Texas Original Application For Coin-Operated Machine General Business License, Import License And/or Repair License And Tax Permit(S) Page 6

Download a blank fillable Form Ap-147-3 - Texas Original Application For Coin-Operated Machine General Business License, Import License And/or Repair License And Tax Permit(S) in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form Ap-147-3 - Texas Original Application For Coin-Operated Machine General Business License, Import License And/or Repair License And Tax Permit(S) with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

Texas Original Application for

AP-147-6

(Rev.8-11/16)

Coin-Operated Machine

General Business License, Import License and/or

Repair License and Tax Permit(s)

Page 4

• Please read instructions.

• Type or print.

• Do NOT write in shaded areas.

Legal name (same as Item 3)

19. TOTAL NUMBER of machines in ALL locations that require tax permits. (Total of Item 18A - F) .................................

___________________

20. Enter the total number of machines that you OWN .......................................................................................................

___________________

License Fee(s) – To determine the license fee due, use the number of machines that you OWN shown in Item 20 and select the correct fee from the

schedule below. NOTE: If you now hold or are applying for a General Business License and/or and Import License, the right to repair machines is

included, and no Repair License or fee is required.

General Business License Fee Schedule

These fees cannot be prorated.

Applicant with 50 or fewer machines ............................................................... $200.00

Applicant with 51 to 200 machines .................................................................. $400.00

Applicant with over 200 machines ................................................................... $500.00

Import license .................................................................................................. $500.00

Repair license .................................................................................................... $50.00

21. Amount due for General Business License ................................................................................................................. $ ____________________

22. Amount due for Import License .................................................................................................................................... $ ____________________

23. Amount due for Repair License ................................................................................................................................... $ ____________________

24. TOTAL LICENSE FEE(S) DUE (Total of items 21 - 23) ............................................................................................... $ ____________________

When you calculate the occupation tax due on your coin-operated machines, DO NOT include coin-operated cigarette, service, merchandise

vending machines, coin-operated amusement machines designed exclusively for children or machines PERMANENTLY taken out of service.

25. Calculate the occupation tax due for all machines placed on location during this application year. Multiply the total number of machines placed on

location for the first time in the appropriate calendar quarter by the rate for that quarter.

a. 1st quarter (January - March): ......

________________

machines at $60.00 each = $ __________________

b. 2nd quarter (April - June): ............

________________

machines at $45.00 each = $ __________________

c. 3rd quarter (July - September): ....

________________

machines at $30.00 each = $ __________________

d. 4th quarter (October - December): ________________

machines at $15.00 each = $ __________________

26. TOTAL OCCUPATION TAX DUE (Total Items 25a, b, c and d) .................................................................................... $ ___________________

27. TOTAL AMOUNT DUE (Item 24 plus Item 26) .............................................................................................................. $ ___________________

Total amount due must be paid with this application.

Date of signature

28. The sole owner, all general partners, corporation or organization president, vice-president, secretary or

month

day

year

treasurer, managing director or an authorized representative and the recordkeeper must sign. A repre-

sentative must submit a written power of attorney.

The law provides that a person who knowingly secures or attempts to secure a license by fraud, misrepresentation or subterfuge is guilty of a

second degree felony and upon conviction is punishable by confinement for two (2) to twenty (20) years and a fine up to $10,000. (Occupations

Code §2153.357; Penal Code §12.33)

I (We) declare that the information in this document and any attachments is true and correct to the best of my (our) knowledge and belief.