Form Ap-146-3 - Texas Original Application For Coin-Operated Machine Registration Certificate And Tax Permit(S) Page 3
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6Texas Original Application
AP-146-3
PRINT FORM
CLEAR FORM
(Rev.8-11/15)
for Coin-Operated Machine
Registration Certificate and Tax Permit(s)
• Please read instructions.
• Type or print.
• Do NOT write in shaded areas.
Page 1
Answer these questions before completing the application.
I. Do you operate or exhibit your machines exclusively in your own place of business which may be owned, leased or rented? ....
YES
NO
If “NO,” stop here. You must apply for a General Business License (Use Form AP-147)
II. Do you own and operate any “Coin-Operated Machines” located in the place of business of another person? ............................
YES
NO
III. Do you have any financial interest, direct or indirect, in the coin-operated music, skill or pleasure machine industry?
(For example: manufacture, own, buy, sell, rent, lease, trade, repair, maintain, service, import, transport or exhibit coin-
operated machines within the state, other than the machine(s) owned and operated by you in your place of business.) .............
YES
NO
If you answered “YES” to Items II or III above, stop here. You must apply for a General Business License.
(Use Form AP-147)
This application is for calendar year _______________________ .
1. Texas Comptroller’s taxpayer number ...........................................................................................
2. Legal name of owner (sole owner, partnership, corporation or other name)
3. Mailing address (street number and name, P.O. Box or rural route and box number)
City
State
ZIP code
County
Business email address
(
)
-
4. Enter the daytime phone number of the person primarily responsible for filing tax returns. ...
-
-
5. Enter your Social Security number if you are a sole owner. ...............................................................
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6. Enter your Federal Employer Identification Number (FEIN), if any. ...........................................................
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7. If you are incorporating an existing business, enter the taxpayer number of the existing business. ....
8. Enter your taxpayer number for reporting any Texas tax OR
your Texas Vendor Identification Number if you now have or have ever had one. ....................................
9. Indicate how your business is owned.
1 - Sole owner
2 - Partnership
3 - Texas corporation
7 - Limited partnership
Foreign corporation
Other (explain) ___________________________________
Charter, file or COA date
State
Texas Secretary of State file number or COA number
month
day
year
10. If this business is a corporation, enter ............................
Home state
Identification number
11. If your business is a limited partnership, enter the home state and identification number. ...........
– All applicants –
Complete the Texas Coin-Operated Machine Ownership Statement, Form AP-138.
12. Trade name of business/machine location
Business phone (area code and number)
(
)
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13. Location of business/machine location
(If business location address is a rural route and box number, provide directions or use 9-1-1 address, if possible.)
City
State
ZIP code
County
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