Arizona Department of Revenue  •  License & Registration Section
                                       PO Box 29032  •  Phoenix  AZ  85038-9032
                                       (602) 716-6056  •  (800) 634-6494 toll free in-state

                                       TRANSACTION PRIVILEGE TAX 
                       LICENSE APPLICATION FOR BOND EXEMPTION

The purpose of  this form  is to  request exemption from  bonding requirements under  A.R.S.  §42-5006  for  construction contracting 
businesses  applying  for a Transaction Privilege Tax License.   Exemptions  are granted based  on the criteria listed in item 3 below.  
For more information on bonding and tax requirements, please refer to the Department of Revenue brochures,   Taxpayer Bonds and 
Contracting Activities.  You can also call the Department of Revenue at the numbers shown above.

Name of Applicant                                                      Name and Title of Contact Person

Federal Employer Identification Number                                 Telephone Number

Address                                                                City                            State  ZIP Code

  1.  Do you have employees employed full-time in Arizona?  Yes     No  
 If, “Yes”, how many:  ____________
  2.  List dates you have had full-time employees in Arizona:  

  3.  If you are requesting exemption from the bonding requirements in accordance with AAC R15-5-601, please check the appropriate 
 box and provide the requested documentation:

   If you have a letter of good standing that verifies timely payment of all sales and transaction privilege taxes from another 
        state in which you have been licensed for at least two years immediately preceding the date of this application, please attach 
        the letter.  If there have been instances of late or insufficient payment, you must include a letter of explanation.

   If the business has no potential liability for transaction privilege tax, you must submit documentation with this application 
        verifying that there is no potential for Arizona tax liability.

   If you have a bond for a previously issued Arizona Transaction Privilege License which adequately covers your previously 
        issued license tax liability and the expected tax liability under this license, please indicate the license number 
        here:  

   If you have a previous license(s) with the Arizona Department of Revenue for which taxes were paid timely and in full, please 
        indicate the license number and the type of license here:   

   If you have engaged in business in Arizona but the business was not subject to transaction privilege tax, please submit 
        copies of your most recent individual or corporate income returns showing that the income was reported and the tax paid.

                                             For Department Use Only

 Bond Required:  $                                                     Expiration Date:   

 Bond Company:  

 Exemption Approval:  

ADOR 10205 (5/15)
                                             Print Form