NEVADA BUSINESS REGISTRATION 
                                          Please see instructions regarding form detail and online registration options. 
 1              I Am Applying For:                          Unemployment Insurance                   Sales/Use Tax Permit             Modified Business Tax            Local Business 
    * SEND A COPY TO EACH AGENCY                 *(Employment Security Division - ESD)                              *(Department of Taxation)                          License 
        New Business                    Change in Ownership/ Business Entity                         Change in Location                              Other 
 2 
                                        Change in Corporate Officers                                 Change in Mailing Address        
                                        Change in Name                                               Add Location 
 3  Business Entity Type:               Sole Proprietor           Association                        LLLP                Limited Liability Partnership             Government Entity 
                                        Corporation               Limited Partnership                Partnership         Limited Liability Company                 Other      
3A  tax filing type                     
    If LLC please check Federal        Corporation                Sole Proprietor                    Partnership 
 4  Corporate/Entity Name                                                                                           Corporate/Entity Telephone       5    Federal Tax Identification Number
    (as shown on State Business License):                                                                           (       )      
 6  Corporate/Entity              Street Number, Direction (N, S, E, W ) and Name   Suite, Unit or Apt #             City, State, and Zip Code +4         State of Incorporation or Formation 
    Address: 
 7  Nevada   Name                                                                                                                    Business Telephone            Fax 
    (DBA):                                                                                                                           (       )                     (       ) 
 8  E-mail Address:                                               Website Address:                                                     9      Nevada Business Identification #: (11 digits) 
                                                                                                                                              NV       
 10 Mailing Address:              Street Number, Direction (N, S, E, W ) and Name   Suite, Unit or Apt #            City, State, and Zip Code +4 
     
 11 Location(s) of Nevada         Street Number, Direction (N, S, E, W ) and Name   Suite, Unit or Apt #            City, State, and Zip Code +4 
    Business Operations:
                                  Street Number, Direction (N, S, E, W ) and Name   Suite, Unit or Apt #            City, State, and Zip Code +4                   Telephone Number: 
 12 Location of        
    Business Records:                                                                                                                                              (      )      
     List All Owners, Partners,     Corporate Officers, Managers, Members, etc. (If individual ownership, list only one owner.) Attach Additional                      Sheets if Needed.
13 
                                  ** The Department of Taxation & Employment Security Division are the only agencies to require a SSN. 
    Last, First, MI :                                             Residence Address (Street)                                             **SSN                       Date of Birth 
    Title                                     Percent Owned       City, State, Zip +4                                                                                Residence Telephone 
    Last, First, MI :                                             Residence Address (Street)                                             **SSN                       Date of Birth 
    Title                                     Percent Owned       City, State, Zip +4                                                                                Residence Telephone 
    Last, First, MI :                                             Residence Address (Street)                                             **SSN                       Date of Birth 
    Title                                     Percent Owned       City, State, Zip +4                                                                                Residence Telephone 
    Responsible Local Contact ( Last, First, MI & Title ):        Residence Address (Street), City, State, Zip +4                        **SSN                       Residence Telephone 
    Date Business Started in Nevada Date Nevada Location Opened      Date First Worker Hired in Nevada    Date of First Nevada Payroll  Amount of First Nevada Payroll   Number of Employees
 14                                                                                                                                                                              
 15                                                         PLEASE CHECK ALL THAT APPLY TO YOUR BUSINESS 
         Mining         Domestics             Outside Dining       Water Appropriation                 Adult Materials/Activity                  Amusement Machines      Registered Agent 
         Service        Agriculture           Home Occupation        Hazardous Material                Leased or Leasing Employees               Alcohol                 Financial Institutions 
         Tobacco        Manufacturing         Retail Sales—New       Construction/Erection             Leasing (Other than Employees)            Gaming                  Mortgage Brokers  
        Delivery        Transportation        Retail Sales—Used      Tire Sales                        Supply/Use Temporary Workers              Health Services         Banker  
         Wholesale      Not for Profit        Live Entertainment     Environmental Discharge           Regulated by Federal/State Permit Number                        Other           ____
        Medical Marijuana 

 16  16         Describe in Detail the Nature of Your Business in Nevada. Include Product Sold, Labor Performed and/or Services Rendered. 
       State the approximate percentage of sales or revenues resulting from each item.  Example: Retail sale of major appliances to public 60%; repair 40%.

 17     If You Have Acquired A Nevada Business, Changed Ownership/Business Entity, or Have a New Federal Tax Number, Complete This Section: 
    Date Acquired/Changed:                                  Acquired/Changed by:          Purchase    Lease      Other                   Portion Acquired/Changed:       In Whole            In Part 
    Name(s) of Previous Owner(s)                                                                    Previous Owner(s) Business Name 
    Address (Street)                                                         City                                                         State                    Zip Code +4 
    Enter Your Previous Nevada Sales/Use Tax Permit Number, if applicable:                          Enter Previous Owner(s) ESD Account Number:

 18                                                              * Signatures must be that of a responsible party *
    I  declare  under  penalty  of  perjury  that  the  information  provided  is  true,  correct  and  complete  to  the  best  of  my  knowledge                               and  belief  and 
    acknowledge that pursuant to NRS 239.330, it is a category C felony to knowingly offer any false of forged instrument for filing.
    *Signature Responsible Party / Original                                       Print Name And Title                                                                         Date
    *Signature  Responsible Party / Original                                       Print Name And Title                                                                         Date

                        ORIGINAL SIGNATURES REQUIRED                               BY AGENCIES – KEEP A COPY FOR YOUR RECORDS 
NSPO Rev. 09.14 (O) 4436                                                                                                                                                      APP-01.00 
                                                                                                                                                                   Revised 09-23             -14 

                     NEVADA BUSINESS REGISTRATION FORM INSTRUCTIONS 
Important details are included to help you provide the necessary information.  It is important to respond to all items.  Any omission could 
cause a delay in processing your registration. 
WHO ACCEPTS THIS FORM? The Nevada Department of Taxation and the Nevada Employment Security Division (ESD).  Some local 
governments may accept this form. 
WHAT OTHER INFORMATION MUST I PROVIDE?  When applying with the Department of Taxation: All businesses must complete a 
Supplemental Application (APP-01.01) to determine correct fees.  When applying with the Employment Security Division: If you employ 
agricultural or domestic workers or are a non-profit agency, you must complete a Supplemental Registration with ESD. 
If you haven’t yet received or applied for a Nevada State Business License, please contact the Nevada Secretary of State at (775) 684-
5708 or complete your registration online at https://www.nvsilverflume.gov. 
LINE-BY-LINE INSTRUCTIONS FOR COMPLETING THE NEVADA BUSINESS REGISTRATION - PLEASE COMPLETE IN ENGLISH. 
 1. I Am Applying For: Check the boxes that apply.  You are required to submit a copy to each agency that is applicable to your
 business.  Keep a copy for your records.
 2. Check All Box(es) That Apply.
 3. Business Entity Type:  Indicate entity type as filed with the Secretary of State.
3A.  If LLC: Indicate type of entity as filed with the IRS. 
 4. Corporate/Entity Name:  Enter the name as registered with the Secretary of State for the State Business License.  Include a
 telephone number.
 5. Federal  Tax  Identification  Number: Enter  your  Federal  Tax  Identification  Number  (FEIN).  For  information  regarding  a  FEIN,
 contact the Internal Revenue Service at 1-800-829-4933 or go to    http://IRS.gov/businesses.  If you have applied for your number
 and have not received it, write “PENDING.”  If your FEIN changes, you must complete a new Nevada Business Registration.
 6. Corporate/Entity Address: Enter the complete address of the corporation and the state of incorporation.
 7. Nevada Name (DBA):  Enter the name as it will be known to the public.  Include a business telephone and fax number.
 8. E-mail Address / Website Address:  Enter Email and Website Address information.
 9. Nevada Business ID Number:  Enter the number as shown on your State Business License or exemption issued by the Secretary
 of State.
10. Mailing Address: This address will be used to mail any licenses, reports, tax returns, and correspondence.
11. Location(s) of Nevada Business Operations:  Enter the physical location of the business including suite numbers, apartment
 numbers, and street direction (N, S, E, and W). If there are additional locations in Nevada, please attach a list of all locations.  You
 may not use a PO Box.
12. Location of Business Records: Enter the physical address where business records are maintained during normal working hours.
 Include the telephone number of this location, if different from the business telephone number.
13. List All Owners, Partners, Corporate Officers, Managers, Members, etc.:          Include the full name, home address (street, city,
 state, and zip code), Social Security Number, date of birth, title, percentage of business owned, and telephone number.  If the
 business is incorporated, list all corporate officers.  If the business is a partnership, list all partners.  If the business is comprised of
 two corporations or other entities, list the officers/members/partners, etc. for each entity.  Attach additional sheets if needed.
14. Dates and Amounts Regarding Your Nevada Business:  Enter the date the business started or will start Nevada operations. If
 adding a location enter the date your additional location will begin Nevada operations.  Enter the date the first worker was hired in
 Nevada. Enter the date and amount of the first Nevada payroll. If this is a new business, enter the estimated number of employees
 you will have. If the business is currently operating, list the number of employees on the payroll.
15. Please Check All That Apply to Your Business:           If you check the box marked “Regulated by Federal/State Permit Number,”
 attach a list that identifies the issuing entity and permit number.
16. Nature of Your Business: Describe your business activities, goods, products, or services in Nevada.  State the approximate
 percentage of sales or revenues resulting from each item.  Example: Retail sale of major appliances to public 60%; repair 40%.
17. Acquired, Changed, or Have a New Federal Tax Number: On the first line, enter the date the business was acquired; check the
 boxes that apply to how the business was acquired; and the portion of the business you acquired.  On the second line, list the
 name of the previous owner and the business name of the previous owner.  On the third line, indicate the physical address of the
 business you acquired.  On the fourth line, list your previous Nevada Sales/Use Tax Permit Number and the Employment Security
 Division (ESD) Account Number of the previous owner.  If there is more than one previous owner, attach an additional sheet.
18. Signature Required:  Legal signatures include:  sole proprietor-owner, corporate officer, managing member and partners.

Toll Free (In State) for All State of Nevada………………………………………………………………………………...                                           800-992-0900
                                                                                                                         
Nevada Department of Taxation:  Online Registration: https://www.nevadatax.nv.gov – Website: http://www.tax.nv.gov 
     Call Center       Toll Free Taxation Help Desk  …………..……………………………………………………..                                       (866) 962-3707 
     Las Vegas…..  555 E Washington Avenue • Suite 1300 • Las Vegas Nevada • 89101……………….......                         (702) 486-2300 
     Reno…………  4600 Kietzke Lane • Building L, Suite 235 • Reno, NV • 89502……………………………..                                (775) 687-9999 
     Carson City….  1550 College Parkway • Suite 115 • Carson City, NV • 89706…………………………......                          (775) 684-2000 

Nevada Employment Security Division (ESD):  Online Registration: https://uitax.nvdetr.org – Website: www.nvdetr.org 
     Las Vegas  …………………………………………………………………………………………………………..                                                              (702) 486-0250 
     Reno  ………………………………………………………………………………………………………………..                                                                 (775) 823-6680 
     Statewide (Mailing)…..  500 E Third Street • Carson City, NV • 89713-0030  .. …………………………..                         (775) 684-6300 
Nevada Department of Wildlife:    (Industrial Artificial Pond Permit) – Website: www.ndow.org.......................... (775) 688-1500 
Nevada Secretary of State:    ………………………………………………………………………..…………………………  (775) 684-5708 
For more information regarding local and state business licensing please visit Nevada’s online Business Portal at 
 https://www.nvsilverflume.gov.  
NSPO Rev. 09.14 (O) 4436                                                                                                 APP-01.01 
                                                                                                                        Revised 09-23-14