Form Cst-250 - Consumers Sales And Use Tax - Application For Direct Pay Permit printable pdf download

Form Cst-250 - Consumers Sales And Use Tax - Application For Direct Pay Permit

West Virginia

Consumers Sales and Use Tax

CST-250

State Tax

Application for Direct Pay Permit

Rev. 07/12

Department

West Virginia Account

Identification Number

Legal Business or

Corporate Name

Owner’s Name

(If Sole Owner)

Street Address

City, State, & Zip Code

Name and telephone

number of contact person

To be CompleTed by owner, parTner or offiCer of CorporaTion

I, the undersigned, hereby certify that:

The above business has a valid

Business Registration Certificate #

The above business is not delinquent on the payment of any taxes imposed by Chapter 11 of the

West Virginia Code; and this business satisfies one or more of the following conditions (check all

that apply):



Engaged in the business of manufacturing

Engaged in the business of gas storage



Engaged in the business of producing natural resources

Engaged in the business of transportation



Engaged in the business of communication

Engaged in the business of transmission



Engaged in the operating of a public utility business

Engaged in the business of research and development



A nationally chartered fraternal or social organization

A bona fide charitable organization that makes no

charge whatsoever for service rendered



Engaged in the business of generation, production, or



A health care provider purchasing drugs, durable medi-

selling of electric power

cal goods, mobility enhancing equipment and prosthetic



A volunteer fire department organized and incorporated

devices that are to be dispensed upon prescription

under the laws of West Virginia

Give a detailed description of your business activity within West Virginia:

On behalf of the above business, I am hereby applying for a direct pay permit.

Under penalties of perjury, I declare that I have examined this return and to the best of my knowledge

and belief it is true, correct, and complete.

Name of applicant (please print or type)

Signature of applicant

Date

Title (Owner, Partner, Officer of Corporation)

Telephone Number

Form Cst-250 - Consumers Sales And Use Tax - Application For Direct Pay Permit

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