Nebraska Tax Application

Nebraska Tax Application

Please consider registering your NEW business online. Most permits are available online immediately upon approval.

11 Reason for Filing Application – Check Appropriate Boxes

Original Application    Change in Owners    Changed Business Entity    Add Tax Program    Other

ID #    Date

7 Type of Ownership

Sole Proprietorship    Partnership    Nonprofit Corporation    Corporation    Foreign Corporation    S Corporation    Governmental    Fiduciary (Estate or Trust)    Nonprofit Organization    Cooperative    Limited Liability Company

8 Accounting Basis

Cash    Accrual    Other

9 Accounting Period (Type of Year)

Calendar – January 1 to December 31    Fiscal – 12 Month Ending    Fiscal – 52 or 53 Week Ending

Business Information

1–6 Identification and Ownership

1 Do you hold, or have you previously held a Nebraska ID number? Yes No

If Yes, provide the number: 2 Federal Employer ID Number (EIN)

3 County of Business Location Within Nebraska 4 Business Classification Code

5 Name and Address of Legal Entity/Owner

6 Identify all Owners and Spouses (if joint ownership), Partners, Members, or Corporate Officers

10 Location of Records

Same as Location Address    Same as Mailing Address    Other Address

Address

City State Zip Code

12 Business Description

a. Primary business type: Retailer Lessor Wholesaler Manufacturer Construction Contractor Other

If you marked “Lessor”, do you lease motor vehicles to others for periods of longer than 31 days? Yes 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.

13 Sales and Use Tax

Sales Tax Permit Enter the date of your first sale

a. Your filing frequency is based on your estimated annual sales and use tax liability: $3,000 or more (monthly) $900 – $2,999 (quarterly) Less than $900 (annually)

b. If you have more than one licensed location, your returns will be filed: Separate for each location Combined for all locations

Will you have a paid preparer file your sales or use tax return? Yes No

Use Tax Permit Enter the date of your first purchase

14 Income Tax Withholding and Income Tax

Income Tax Withholding Enter the date of the first wages paid

a. Will your average Nebraska monthly income tax withholding exceed $500? Yes No

b. Will your annual Nebraska income tax withholding be less than $500 per year? Yes No

Have you been allowed to file federal withholding returns annually? Yes No

If you answered Yes to either of the questions in “b,” mark filing frequency preference Quarterly Annually

c. Income tax withholding returns will be filed: For each separate location Consolidated for all locations Consolidated by region or district

d. Will you have a payroll service prepare your returns? Yes No

e. Additional business operations employing Nebraska residents

Corporate Income Tax Are you an S Corporation? Yes No

Partnership Income Tax Fiduciary Income Tax Financial Institution Tax

15 Miscellaneous Tax Programs

Tire Fee Permit Lodging Tax Permit Litter Fee License Severance and Conservation Prepaid Wireless Surcharge

16 Person to Contact Regarding this Application

Authorized Contact Person

Title Email Address Phone Number

Under penalties of law, I declare that I have examined this application, and to the best of my knowledge and belief, it is correct and complete.

Read the attached instructions about Nebraska licensing or registration requirements and complete the information for all tax programs you need to be licensed or registered for.