Form Ap-144 - Coin-Operated Machine Inventory Supplement For Registration Certificate Holders

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AP-144
(Rev.6-04/5)
COIN-OPERATED MACHINE INVENTORY SUPPLEMENT
FOR REGISTRATION CERTIFICATE HOLDERS
For Comptroller Use Only
NOTE: This supplement is to be used to record your machine inventory for each location YOU MUST PROVIDE THIS
INFORMATION (Occupations Code, 2153.158). Please attach copies if necessary. This form must be returned
00990
4420
with your application for coin-operated machine tax registration certificate and tax permits.
• TYPE OR PRINT
• DO NOT WRITE IN SHADED AREAS
1. Legal name of owner
Taxpayer number
(Sole owner, partnership, corporation, or other name)
2. Trade name of business/machine location
Business phone
(Area code and number)
3. Location of business/machine location
(If business location address is a rural route and box number, provide directions – e.g., “2 miles west of Austin on RM 2222.”)
City
State
ZIP Code
County
4. For each machine at this location (Item 3, above), list the serial number/inventory I.D. number, machine make, and machine type. For each
additional location, complete a separate Machine Inventory Supplement for Registration Certificate Holder, Form AP-144, or a COMPUTER
PRINTOUT OF ALL NUMBERED INVENTORY MAY BE USED. If you use a computer printout, you MUST complete Items 5 and 6.
MACHINE SERIAL NUMBER/
EXHIBITED OR DISPLAYED
MACHINE TYPE CODE
MACHINE MAKE OR MANUFACTURE
INVENTORY I.D. NUMBER
(Use letter codes from Item 5.)
ON LOCATION
1
YES
NO
2
YES
NO
3
YES
NO
4
YES
NO
5
YES
NO
6
YES
NO
7
YES
NO
8
YES
NO
9
YES
NO
10
YES
NO
11
YES
NO
12
YES
NO
13
YES
NO
14
YES
NO
15
YES
NO
16
YES
NO
17
YES
NO
18
YES
NO
19
YES
NO
20
YES
NO
5. Enter the number of EACH TYPE of music, skill, or pleasure coin-operated machine that you have in ALL locations.
– A –
– B –
– C –
– D –
– E –
– F –
PHONOGRAPHS
POOL TABLES
PINBALL GAMES
VIDEO GAMES
DARTS
OTHER
6. TOTAL NUMBER of machines in ALL locations that require tax permits. (Total of Item 5 A - F) ..................................
___________________
You have certain rights under Chapters 552 and 559, Government Code, to review, request and correct information we have on file about you.
Contact us at the address or phone number listed on your application.

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