Form Rv-F1303601 - Application For Franchise, Excise Tax Registration
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APPLICATION FOR FRANCHISE,
EXCISE TAX REGISTRATION
NOTE: Complete Sections 1 and 2 only if the information is different from the mailing label below
1.
BUSINESS NAME AND LOCATION ADDRESS
2.
BUSINESS MAILING ADDRESS
LEGAL NAME
P.O. BOX, STREET, ROUTE, OR HIGHWAY
STREET, HIGHWAY (DO NOT USE P.O. BOX NUMBER OR RURAL ROUTE NUMBER)
STATE
ZIP CODE
CITY
STATE
ZIP CODE
COUNTY
CITY
TN
TN
3A.
BUSINESS PHONE # (
) _______________
3B.
BUSINESS FAX # (
) __________________
4.
/
FISCAL YR. END
DAY
MO
ANSWER ALL QUESTIONS COM-
PLETELY. INCOMPLETE AND UN-
SIGNED APPLICATIONS WILL DELAY
PROCESSING.
APPLIED FOR
5.
ENTER YOUR FEDERAL EMPLOYER'S IDENTIFICATION #
6.
TYPE OF ENTITY:
7.
SECRETARY OF STATE #
LIMITED LIABILITY PARTNERSHIP
LIMITED PARTNERSHIP
LIMITED LIABILITY COMPANY
PROFESSIONAL LIMITED LIABILITY COMPANY
S CORPORATION
CORPORATION
PROFESSIONAL CORPORATION
NOT-FOR-PROFIT
OTHER
8.
If the entity is a Series LLC, provide the following information for the Master LLC: Federal EIN, Entity Name, Location Address, Telephone
Number, and State of Domestic Certificate of Authority.
9.
IF A LIMITED PARTNERSHIP, LIMITED LIABILITY PARTNERSHIP, OR LIMITED LIABILITY COMPANY, DID ONE OR MORE CORPORATIONS SUBJECT TO
TENNESSEE TAX, DIRECTLY OR INDIRECTLY, HAVE IN THE AGGREGATE 80% OR MORE OWNERSHIP INTEREST AT ANY TIME AFTER JUNE 30,1998,
PLEASE CHECK THE APPROPRIATE BOX AT RIGHT.
YES
NO
10.
IDENTIFY PRINCIPAL OFFICERS, PARTNERS OR MEMBERS AND PERCENT OF OWNERSHIP IN THIS BUSINESS (ATTACH ADDITIONAL NAMES AND
SOCIAL SECURITY NUMBERS ON SEPARATE SHEET)
SSN / FEIN (Please circle which format is provided)
(1) NAME
TELEPHONE #
% OF OWNERSHIP
ADDRESS (DO NOT USE P.O. BOX #)
CITY
STATE
ZIP CODE
TN
SSN / FEIN (Please circle which format is provided)
(2) NAME
TELEPHONE #
CITY
STATE
ZIP CODE
ADDRESS (DO NOT USE P.O. BOX #)
% OF OWNERSHIP
TN
(3) NAME
TELEPHONE #
SSN / FEIN (Please circle which format is provided)
ADDRESS (DO NOT USE P.O. BOX #)
CITY
STATE
ZIP CODE
% OF OWNERSHIP
TN
ARE YOU STILL IN BUSINESS? IF NO LONGER IN BUSINESS, PLEASE
CHECK NO AND RETURN APPLICATION WITH CLOSURE DATE.
YES
NO
DATE: ______________________
THE STATEMENTS MADE ON THIS APPLICATION ARE TRUE TO THE
FOR DEPARTMENT USE ONLY
11.
BEST OF MY KNOWLEDGE AND BELIEF. (THIS APPLICATION MUST BE
SIGNED BY A PRINCIPAL OFFICER, PARTNER, OR MEMBER OF THE
CORPORATION LISTED IN ITEM 10.)
SIGN
HERE:
PRINCIPAL OFFICER, PARTNER OR MEMBER (DO NOT PRINT OR USE STAMP)
TITLE
DATE
RV-F1303601 (Rev. 10-11)
INTERNET (10-11)
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