Taxpayer Identification

Business Information

10. If your business is a Texas Corporation, enter the charter number and date:
11. If your business is a foreign corporation, enter the following:
12. If your business is a limited partnership, enter the following:
13. List all general partners or principal officers of your business.
I/We, the undersigned, acknowledge that I/We are fully responsible for compliance with all WORD requirements and remittance of taxes. The failure of My/Our hired staff or partners does not excuse this responsibility.
Match the name and the address with the appropriate (letter marked) space provided.

Name (First, Middle, Last)

Title

(a)

(b)

(c)

(c)

Home Address (Street & No., State, Zip)

Phone

(a)

(b)

(c)

(d)

Successor Information

If you purchased an existing business or business assets, complete items 14 thru 17.

15. Enter the former owner’s legal name. If known, enter the former owner’s address and telephone:

Business Information

List multiple outlets separately in spaces below:

Enter the name and contact number of the person primarily responsible for filing tax returns and any other persons authorized to file taxes on your behalf:
The owner is legally responsible for all errors

Signatures

The sole owner, all general partners, corporation president, vice-president, secretary or treasurer or an authorized representative must sign this application. The authorized representative must submit a written authority such as a power of attorney with this application (attach additional signature sheet if necessary) If using a third-party tax preparer, the business owner must sign this application.

By checking the box below, I (We) declare that the information in this document and any attachments are true and correct to the best of my (our) knowledge and belief:

Upcoming Events

Wed 20

Board Meeting

November 20 @ 5:30 pm - 7:30 pm
Thu 28
Dec 03

Flood Siren Testing

December 3 @ 10:00 am - 11:00 am
Dec 18

Board Meeting

December 18 @ 5:30 pm - 7:30 pm