HTML Preview Income Tax Job Application Form page number 1.
7-100-1975 Rev. 11-2014 Supersedes 7-100-1975 Rev. 9-2014
12 Provide a description of your business operations, products that you sell, and services that you provide.
a. Primary business type: c Retailer c Lessor c Wholesaler c Manufacturer c Construction Contractor c Other
If you marked “Lessor”, do you lease motor vehicles to others for periods of longer than 31 days? c Yes c No
b. If your business does not operate year-round, identify the months you operate.
c. How many business establishments do you operate: in Nebraska? in U.S.A.?
d. If you purchased an existing business, identify the previous owner.
Form
20
Complete Reverse Side
Name Address City Zip Code Nebraska ID Number
Nebraska Tax Application
11 Reason for Filing Application – Check Appropriate Boxes. If box 3 is checked, you may cancel your old Nebraska ID number on the final
return, on a Form 22, or by providing the number and final date in box 3 below.
(1) c Original Application (3) c Changed Business Entity (To cancel Nebraska ID number (4) c Add Tax Program
(2) c Change in Partners of previous entity, write the ID number and final date here: (5) c Other (attach explanation)
ID #_________________________ Date_______________)
From - To -
c Sole Proprietorship c Sole Proprietorship
c Partnership c Partnership
c Limited Liability Company c Limited Liability Company
c Corporation c Corporation
9 Accounting Period (Type of Year) (see instructions)
(1) c Calendar – January 1 to December 31
(2) c Fiscal – 12 Month Ending
(3) c Fiscal – 52 or 53 Week Ending
8 Accounting Basis
(1) c Cash
(2) c Accrual
(3) c Other
7 Type of Ownership
(1) c Sole Proprietorship (5) c
Foreign Corporation (another state or country)
(9) c Nonprofit Organization
(2) c Partnership (6) c S Corporation (10) c Cooperative
(3) c Nonprofit Corporation (7) c Governmental (11) c Limited Liability Company
(4) c Corporation (8) c Fiduciary (Estate or Trust)
Name Doing Business As (dba) Name
Legal Name
Business Street Address (Do Not Use PO Box) Street or Other Mailing Address
City State Zip Code City State Zip Code
Name and Location Address of Business (print clearly) Name and Mailing Address
1 Do you hold, or have you previously held a Nebraska
ID number?
c Yes c No
If Yes, provide the number:
2 Federal Employer ID Number (EIN)
3 County of Business Location Within
Nebraska
4 For Department Use Only
Please Do Not Write In This Space
5 Name and Address of Legal Entity/Owner
Is your Nebraska location within the city limits? (1) c Yes (2) c No
10 Location of Records
(1) c Same as Location Address (3) c Other Address (provide below)
(2) c Same as Mailing Address
6 Identify Owner and Spouse (if joint ownership), Partners, Members, or Corporate Officers (one of the listed individuals must sign as applicant).
Social Security Number Name, Address, City, State, Zip Code Title, If Corporate Officer
Address City State Zip Code
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