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                                                                                                                                      *AP20110F062427*PRINT FORM             CLEAR FIELDS
                                                                                                                                      *AP20110F062427*      Instructions in English
                                                                                                                                      * A    P            2 0  1 1    0  W    0   7        2 4   2  8     *
                                Texas Application
                                • Sales Tax Permit   •   Use Tax Permit   •   9-1-1 Emergency Communications
                                • Prepaid Wireless 9-1-1 Emergency Service Fee
                                • Off-Road, Heavy-Duty Diesel Powered Equipment Surcharge

                     G LENN HEGAR                              TEXAS COMP TROLLER OF PUBLIC A CCOUNTS

          If you are a sole proprietor, start on the next page, Item 10. 

          1.  Business Organization Type
             Profit Corporation (CT, CF)                                         General Partnership (PB, PI)                                             Business  rustT(TF)
             Nonprofit Corporation (CN, CM)                                      Professional Association (AP, AF)                                        Trust (TR) Submit a copy of the trust agreement 
                                                                                                                                                                     with this application.
             Limited Liability Company (CL, CI)                                  Business Association (AB, AC)                                            Real Estate Investment  rustT    (TH,  TI)
             Limited Partnership (PL, PF)                                        Joint Venture (PV, PW)                                                   Joint Stock Company (ST, SF)
             Professional Corporation (CP, CU)                                   Holding Company (HF)                                                     Estate (ES)
             Other (explain)
          2. Legal name of corporation, partnership, limited liability company, association or other legal entity

          3. Federal Employer Identification Number (FEIN) ........                                                4.                 Check here if you DO NOT have an FEIN.
          (assigned by the Internal Revenue Service for reporting federal income taxes)
                                                                                                                                                          3
          5.List any current or past 1 1-digit  exas TaxpayerTNumber for reporting
          any taxes or fees to the  exasTComptroller of Public       Accounts. ...........................................................................
          6.Have you ever received a  exasTvendor or payee number
(         (Texas Identification Number/T     IN)? ........................................ YES       NO       If "YES," enter number          ...
                                                                                                                          State/country                              Month   Day             Year
          7. Enter the home state or country where this entity was formed and the formation date ............   
 TION                                                                                                                     File number
          Enter the home state registration/file number ...........................................................................   
                                                                                                                          File number
  INFORMA Non-Texas entities: enter the file number if registered with the  exas SecretaryT    of State           ........
          8. If the business is a corporation, has it been
 ENTITY   involved in a merger within the last seven years? ......................         YES         NO        If "YES," attach a detailed explanation. (See instructions.)

          9. List all general partners, officers or managing members (Attach additional sheets, if necessary.)
          Name                                                                                 Phone (Area code and number)

          Home address                                                           City                                                   State               ZIP code

          SSN                                         FEIN                                     Percent of                             County (or country, if outside the U.S.)
                                                                                               ownership                  %

          Position held:        General Partner            Officer/Director                Managing Member         Other
          Name                                                                                 Phone (Area code and number)

          Home address                                                           City                                                   State               ZIP code

          SSN                                         FEIN                                     Percent of                             County (or country, if outside the U.S.)
                                                                                               ownership                  %

          Position held:        General Partner            Officer/Director                Managing Member         Other

          If you are not a sole proprietor, go to Item 15.

AP-201-1 (Rev.7-24/28)

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AP-201-2
(Rev.7-24/28) *AP20120F062427*
Texas Application for *AP20120F062427*
* A P 2 0 1 2 0 W 0 7 2 4 2 8 *
Sales Tax Permit and/or Use Tax Permit Page 2
You have certain rights under Chapters 552 and 559, Government Code,
to review, request and correct information we have on file about you.
• TYPE OR PRINT • Do NOT write in shaded areas. Contact us at the address or numbers listed on this form.

If you are a sole proprietor, start here.
(If you are NOT a sole proprietor, skip to Item 15.)

10. Legal name of sole proprietor (first, middle initial, last)

ORS
Check this box if you DO NOT have
11. Social Security number (SSN) ............. a Social Security number (SSN).

12.List any current or past 11-digit exas TaxpayerTNumber for reporting
any taxes or fees to the exasTComptroller of Public Accounts. ...........................................................................
SOLE PROPRIET
13.Have you ever received a exasTvendor or payee
number (Texas Identification Number/TIN)? .......... YES NO If "YES," enter number ..............

14. Federal Employer Identification Number (FEIN), if you have one, assigned by
the Internal Revenue Service for reporting federal income taxes. .............................................................................

All applicants continue here.
15. Mailing address of taxpaying entity - This address is for an individual or the person responsible for making decisions regarding address changes and
banking changes and who is responsible for overall account management and account security. Enter complete address including suite, apartment
or personal mailbox number. Indicate whether the address is on a street, avenue, parkway, drive, etc., and whether there is a directional indicator
(e.g., North Lamar Blvd.).
Street number and name, P.O. Box or rural route and box number Suite/Apt. #

City State/province ZIP code County (or country, if outside the U.S.)

16. Daytime phone number (Area code and number) ..........................................................................................

17. FAX number (Area code and number) ............................................................................................................

18. Mobile/cellular phone number (Area code and number) .................................................................................

19. Business website address(es) ...........

APPLICANTS 20. Contact person for business records
ALL Name Email address

Street address (if different from the address in Item 15) Phone number (Area code, number and extension)

21. Alternate contact person for business records
Name Email address

Street address (if different from the address in Item 15) Phone number (Area code, number and extension)

22. Name of bank or other financial institution (Attach additional sheets, if necessary.)
Business Personal

23. If you will be accepting payments by credit card and/or through Merchant identification number (MID)
an online payment processing company, enter the name of the processor. assigned by processor

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AP-201-3
(Rev.7-24/28) *AP20130F062427*
Texas Application for *AP20130F062427*
* A P 2 0 1 3 0 W 0 7 2 4 2 8 *
Sales Tax Permit and/or Use Tax Permit Page 3
Legal name (Same as Item 2 OR Item 10)

Complete all information in this section for each PLACE OF BUSINESS in Texas.
If you do not have a physical PLACE OF BUSINESS in Texas, skip to Item 30.
24. PLACE OF BUSINESS name and address - This address is for a physical location operated for the purpose of selling taxable items where sales per-
sonnel receive three or more orders for taxable items during the calendar year. (Attach additional sheets for each PLACE OF BUSINESS in Texas.)
Business name (DBA)

Street address (include St, Av, Ct, etc.) or rural route and box number (Do NOT use P.O. Box address--must provide physical location address.) Suite/Apt. number

City State ZIP code Business location phone
T X
If this PLACE OF BUSINESS address is difficult to find or includes a rural route and box number, provide the physical location or directions.

See instructions prior to answering Items 25 and 26.
25. Within what city limits is this PLACE OF BUSINESS?
Check this box if this PLACE OF BUSINESS is
NOT located within the limits of a city in Texas.
26. Within what county is this PLACE OF BUSINESS?

27. Is this PLACE OF BUSINESS operated from your home? .......................................................................................................... YES NO
28.Do you ship or deliver items to cities or counties in exas otherT than where you have your place of business? ......................... YES NO
29. Enter the name and address of the owner or landlord of this PLACE OF BUSINESS.

30. Do you maintain a distribution center, warehouse, office or any other physical location where business is
conducted in Texas? ..................................................................................................................................................................... YES NO
If "YES", list the location of all distribution points, warehouses or offices in exas. T (Do not include locations that are considered a PLACE OF
BUSINESS.) (Attach additional sheets, if necessary.)
Street City State ZIP code
T X
T X
31. Do you have any representative, agent, salesperson, canvasser or solicitor who operates under your authority to conduct business in Texas,
PLACE OF BUSINESS INFORMATION including selling, delivering or taking orders for taxable items? ................................................................................................... YES NO
If "YES", list names and addresses of all representatives, agents, salespersons, canvassers or solicitors in Texas.
(Attach additional sheets, if necessary)
Name (first, middle initial, last)

Street address City State ZIP code
T X
32.Do you own, use, sell, lease or rent tangible personal property located in exas? (ThisT includes storing machinery
and equipment.) ............................................................................................................................................................................ YES NO
33. Do you provide onsite taxable services at customer locations in Texas? ..................................................................................... YES NO
34.Do you sell at temporary locations (fairs, trade shows, etc.) in exas? T ....................................................................................... YES NO
If "YES", list the locations or event names and when you will be at location or event. (Attach additional sheets, if necessary)
Location and/or event name (e.g., Canton First Mondays, State Fair in Dallas, etc.) Period in attendance (e.g., first weekend of each month, late October, etc.)

35. Do you have a franchisee or licensee operating under your name who is required to collect sales and use taxes in Texas? ..... YES NO
36.Do you have a substantial ownership in, or are owned in whole or substantial part, by a person who has a business location in exas and T
sells the same or similar line of products under a business name that is similar to your business name? .................................. YES NO
37.Do you have a substantial ownership in, or are owned in whole or substantial part, by a person who maintains a location in exas to T
advertise, promote or facilitate sales, deliveries or returns of your products? .............................................................................. YES NO

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AP-201-4
(Rev.7-24/28) *AP20140F062427*
Texas Application for *AP20140F062427*
* A P 2 0 1 4 0 W 0 7 2 4 2 8 *
Sales Tax Permit and/or Use Tax Permit Page 4
Legal name (Same as Item 2 OR Item 10)

38. Do you have internet or mail order sales? .................................................................................................................................... YES NO
39. Are you a Marketplace Provider? ................................................................................................................................................. YES NO
40. Will your anticipated monthly taxable sales exceed $8,000 per month? ...................................................................................... YES NO
41. Will you sell alcoholic beverages? ............................................................................................................................................... YES NO
If "YES", which permit will you hold? ........................................................................................ MIXED BEVERAGE BEER AND WINE
42.Is this permit for a winery located outside of exas thatT will ship wine to consumers in exas? T ................................................ YES NO
If "YES," you must obtain an Out-of-State Winery Direct Shipper's Permit from the Texas Alcoholic Beverage Commission. (See instructions.)
Enter the exasTAlcoholic Beverage Commission license number(s) for this address.

TION
43. Will you sell memberships to a health spa? ................................................................................................................................. YES NO
If "YES," you must attach a copy of your Health Spa certificate of registration issued by the Texas Secretary of State.
44. Will you sell electronic cigarettes or any other device that simulates smoking by using a mechanical heating element,
battery or electronic circuit to deliver nicotine or other substances to the individual inhaling from the device? .......................... YES NO
TED INFORMA 44a. If "YES," are you planning to sell electronic cigarettes over the internet, by mail order or by telephone? .......................... YES NO
44b. If "YES" in 44a above, enter your email address or URL
RELA
45. Will you sell fireworks? ................................................................................................................................................................ YES NO

46.If you have answered “NO” to questions 30-37, 39 and 43, do you elect to use the optional Single Local ax (SLT) rate?T ....... YES NO
Month Day Year
47. Enter the date that you will begin making sales? .................................................................................................................
48. Will you operate this business all year? ....................................................................................................................................... YES NO
If "NO," list the months you will operate __________________________________________________________________________________
NAICS code
49. Enter your North American Industry Classification System (NAICS) code. (See specific instructions.) .......................................
If you don't know your NAICS code, indicate your principal type of business.
Agriculture Transportation Retail radeT Real Estate Direct Sales / Marketing
Mining Finance Services Communications (See Item 38.)
Construction Utilities Insurance Public Administration
Manufacturing Wholesale radeT Health Spa Other (explain)
Primary business activity and type of products or services to be sold.

50. Will you be required to report interest earned on sales tax? (See specific instructions.) ............................................................. YES NO
51. Will you sell, lease or rent off-road, heavy-duty (50 horsepower or more) diesel-powered equipment? ................................... YES NO
52. If you will be providing telecommunications services, indicate the 9-1-1 emergency communications fees you collect under Health & Safety Code,
Chapter 771.
1 FEES 9-1-1 Wireless Emergency Service Fee (91) 9-1-1 Emergency Service Fee (92) 9-1-1 Equalization Surcharge (93)
91
53. Will you sell prepaid wireless telecommunications services? ....................................................................................................... YES NO
If you purchased an existing business or business assets, complete Item 54; if not, skip to Item 55. Previous owner’s Texas taxpayer
54. Previous owner's trade name (DBA name) number (if available)

Previous owner s’legal name, address and phone number, if available
Name Title Phone (Area code and number)

Street address City State ZIP code

PREVIOUS OWNER Check each of the following items you purchased. Inventory Corporate stock Equipment Real estate Other assets
Purchase price of this business or assets and the date of purchase Month Day Year
Purchase price $ Date of purchase

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               AP-201-5
               (Rev.7-24/28)                                                                                                               *AP20150F062427*
                               Texas Application for                                                                                       *AP20150F062427*
                                                                                                                                           *       A  P 2    0 1 5 0 W  0   7 2      4   2                   8 *
               Sales Tax Permit and/or Use Tax Permit                                                                                                                                    Page 5
Legal name (Same as Item 2 OR Item 10)  

                 APPLICANTS MUST BE AT LEAST 18 YEARS OLD. Parents or legal guardians can obtain a sales tax permit on behalf of a minor.
                                                                                                                                                                 Date of signature(s)
 55.  The sole owner, ALL general partners, managing members, officers, directors or an authorized representative                                                 Month Day          Year
               must sign. The representative must submit a written power of attorney. (Attach additional sheets, if necessary.)
               I (We) declare that the information in this document and any attachments is true and correct to the best of my (our) knowledge and belief.
               Type or print name and title of sole owner, partner, officer, director or member
                                                                                                            Sole owner, partner, officer  director,or member 
               Driver license number/state         Are you at least 18 yrs of age
                                                   or older?
                                                   YES                             NO
               Type or print name and title of partner, officer, director or member
 TURES                                                                                                      Partner, officer, director or member 
               Driver license number/state         Are you at least 18 yrs of age
 SIGNA                                             or older?
                                                   YES                             NO
               Type or print name and title of partner, officer, director or member
                                                                                                            Partner, officer, director or member 
               Driver license number/state         Are you at least 18 yrs of age
                                                   or older?
                                                   YES                             NO
               WARNING. You may be required to obtain an additional permit or license from the State of Texas or from a local governmental entity to 
               conduct business. A listing of links relating to acquiring licenses, permits, and registrations from the State of Texas is available online 
               at https://www.texas.gov/. You may also want to contact the municipality and county in which you will conduct business to determine  
               any local governmental requirements.

               You can submit your completed application by mail, email or fax:
               Mail:         Comptroller of Public Accounts                        Email:       sales.applications@cpa.texas.gov
                             111 E. 17th St.                                       Fax:         512-936-0010
                             Austin, TX 78774-0100
               You will receive your permit approximately four weeks after we receive your completed and signed application. Incomplete applications will delay 
               the process.
 INSTRUCTIONS  FEDERAL PRIVACY ACT — Disclosure of your social security number is required and authorized under law, for the purpose of tax administration and identification of any individual affected 
               by applicable law, 42 U.S.C. §405(c)(2)(C)(i); Tex. Govt. Code §§403.011 and 403.078. Release of information on this form in response to a public information request will be governed by the 
               Public Information Act, Chapter 552, Government Code, and applicable federal law.
               You have certain rights under Chapters 552 and 559, Government Code, to review, request and correct information we have on file about you. Contact us at the address or phone number listed 
               on this form.

 Field office or section number              Employee name                                                                                 USERID                    Date

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