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