301018
          KANSAS BUSINESS TAX APPLICATION
PART 1 – REASON FOR APPLICATION (mark one)                                          NOTE: If registered but adding another business                 RCN
                                                                                    location, you need only complete CR-17 (page 11).
 Registering for additional tax type(s)
 Started a new business                                                                                                                            FOR OFFICE USE ONLY
 Purchased an existing business. Enter federal Employer ID Number (EIN) of previous owner: ____________________________________
  See instructions on page 2 for important Tax Clearance information.

PART 2 – TAX TYPE (check the box for each tax type or license requested and complete the required Parts of this application).
 Retailers’ Sales Tax                                        Dry Cleaning Surcharge                                      Nonresident Contractor
  (Complete Parts 1, 2, 3, 4, 5 & 12)                          (Complete Parts 1, 2, 3, 4, 5 & 12)                          (Complete Parts 1, 2, 3, 4, 5, 11 & 12)
 Retailers’ Compensating Use Tax                             Liquor Enforcement Tax                                      Water Protection/Clean Drinking Water Fee
  (Complete Parts 1, 2, 3, 4, 5 & 12)                          (Complete Parts 1, 2, 3, 4, 8 & 12)                          (Complete Parts 1, 2, 3, 4, 5 & 12)
 Consumers’ Compensating Use Tax                             Liquor Drink Tax                                                  IMPORTANT: Businesses are required  to 
  (Complete Parts 1, 2, 3, 4, 5 & 12)                          (Complete Parts 1, 2, 3, 4, 9 & 12)                               electronically file returns and/or reports for 
 Withholding Tax                                             Cigarette Vending Machine Permit                                  Kansas Retailers’ Sales, Compensating 
  (Complete Parts 1, 2, 3, 4, 6 & 12)                          (Complete Parts 1, 2, 3, 4, 10 & 12)
                                                                                                                                 Use, Withholding, Liquor Drink, Liquor 
 Transient Guest Tax                                         Retail Cigarette/Electronic Cigarette License                     Enforcement, Cigarette, Consumable 
  (Complete Parts 1, 2, 3, 4, 5 & 12)                          (Complete Parts 1, 2, 3, 4, 10 & 12)
                                                                                                                                 Materials  and  Tobacco  taxes.  See  the 
 Tire Excise Tax                                             Corporate Income Tax                                              electronic  file  and pay options 
  (Complete Parts 1, 2, 3, 4, 5 & 12)                          (Complete Parts 1, 2, 3, 4, 7 & 12)
 Vehicle Rental Excise Tax                                   Privilege Tax                                                     available to you on page 13, or visit 
  (Complete Parts 1, 2, 3, 4, 5 & 12)                          (Complete Parts 1, 2, 3, 4, 7 & 12)                               our website at ksrevenue.gov.

PART 3 – BUSINESS INFORMATION (please type or print).
1.  Type of Ownership (check one):            Sole Proprietor                                         Limited Partnership                          General Partnership
   Limited Liability Partnership             Limited Liability Company                               Federal Government                           Other Government
   Non-Profit Corporation                    Limited Liability Sole Member                           Other: _________________________________
   S Corporation     Date of Incorporation: _________________________________________________                    State of Incorporation: _______________________________________
   C Corporation     Date of Incorporation: _________________________________________________                    State of Incorporation: _______________________________________
2.  Business Name: ______________________________________________________________________________________________________________________________________________________________________
3.  Business Mailing Address (include apartment, suite, or lot number): __________________________________________________________________________________________________________
  City:  ___________________________________________________________________ County:  ___________________________________   State: ____________  Zip Code:___________________________
4.  Business Phone:  ______________________________________________________________                               Business Fax: _______________________________________________________
  Email: _________________________________________________________________________________________________________
5.  Business Contact Person       (By filling out Part 3, line 5 of this Business Tax Application you authorize this person or entity to receive, discuss and inspect confidential 
  tax information on your behalf with the Kansas Department of Revenue. This authorization will remain in effect until you revoke it.):
  Name: _______________________________________________________________________________________________________________________   SSN: ______________________________________________
  Country: ___________________________   Contact Address:  __________________________________________________________________________________________________________________________
  City:  ___________________________________________________________________ State: ________________  Zip Code: _________________________        County: ______________________________
  Phone:___________________________________  Email:______________________________________________________________________________________
6.  Federal Employer Identification Number (EIN): __________________________________________________________________  (DO NOT enter Social Security number here)
7.  Accounting Method (check one):      Cash Basis                    Accrual Basis
8.  Describe your primary (taxable) business activity: __________________________________________________________________________________________________________________________
  Enter business classification NAICS Code (see instructions on page 5):  ________________________________________________________________________________________________
9.  Parent Company Name (if applicable):  ___________________________________________________________________________________________________________________________________________
  Parent Company EIN: ______________________________________________________
  Parent Company Address (include apartment, suite, or lot number):  __________________________________________________________________________________________________________
  City:  ____________________________________________________  County: ___________________________________________________  State: _______________  Zip Code: __________________________
10. Subsidiaries (if applicable). If more than two, list them on a separate sheet and enclose it with this form.
  Name: ________________________________________________________________________________________________________________    EIN: __________________________________________________________
  Company Address (include apartment, suite, or lot number): _____________________________________________________________________________________________________________________
  City:  ____________________________________________________  County: ___________________________________________________  State: _______________  Zip Code: __________________________
  Name: _______________________________________________________________________________________________________________     EIN: __________________________________________________________
  Company Address  (include apartment, suite, or lot number): ____________________________________________________________________________________________________________________
  City:  ____________________________________________________  County: ___________________________________________________  State: _______________  Zip Code: __________________________
                                                                                                                                  FOR OFFICE
CR-16 (Rev. 6-22)                                              (Part 3 continues on next page)                                    USE ONLY
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ENTER YOUR EIN: _____________________________________________________           OR                                       SSN: _______________________________________________________

PART 3 – (continued)
11. Have you or any member of your firm previously held a Kansas tax registration number? No  Yes  If yes, list previous number or 
name of business:______________________________________________________________________________________________________________________________________________________________________
12. List all Kansas registration numbers currently in use: _____________________________________________________________________________________________________________________
13. List all registration numbers that need to be closed due to the filing of this application: ______________________________________________________________________
 ________________________________________________________________________________________________________________________________________________________________________________________________
14. Are you registered with Streamlined Sales Tax (SST)?                No   Yes  If yes, enter SST ID #:                    S _____________________________________

PART 4 – LOCATION INFORMATION (If you have only one business location, complete Part 4. If you have more than one location, 
complete Part 4 and form CR-17 for each additional location. This form is on page 11).
1. Trade name of business: _____________________________________________________________________________________________________________________________________________________________
2. Business Location (include apartment, suite, or lot number): ___________________________________________________________________________________________________________
City: _____________________________________________________  County:  _________________________________________________  State: ______________ Zip Code:  __________________________
3. Is the business location within the city limits?           No      Yes  If yes, what city? ___________________________________________________________________________
4. Describe your primary business activity:  _______________________________________________________________________________________________________________________________________
Enter business classification NAICS Code (see instructions on page 5): ___________________________________________________________________________________________
5. Business phone number: ________________________________________________
6. Is your business engaged in renting or leasing motor vehicles?            Yes  No  Are the leases for more than 28 days?  Yes                            No
7. Is this location a hotel, motel, or bed and breakfast?            No   Yes  If yes, number of sleeping rooms available for rent/lease:  _____________
If 3 rooms or less, do you have retail sales or rentals other than those included in the price of the sleeping accommodations?                           Yes  No
8. Do you sell new tires and/or vehicles with new tires?             Yes     No Estimate your monthly tire tax ($.25 per tire): $ ____________________
9. If you are a dry cleaner or laundry retailer, do you have satellite locations or agents in businesses not classified as a dry cleaning or laundry 
facility?  No  Yes If yes, enclose a schedule with name, business type, address, city, state, and zip code of each satellite location.
10. Are you a public water supplier making retail sales of water delivered through mains, lines, or pipes?                      Yes            No
11. Do you make retail sales of motor vehicle fuels or special fuels?         No   Yes  If yes, you must also have a Kansas Motor Fuel 
Retailers License. Complete and submit application form MF-53 for each retail location.

PART 5 – SALES TAX AND COMPENSATING USE TAX
1.  Date retail sales/compensating use began (or will begin) in Kansas under this ownership:  _____________________________________
2.  Do you operate more than one business location in Kansas?              No     Yes        If yes, how many? _________  (Complete a form CR-17 
(page 11)) for each location in addition to the one listed in PART 4. Sales for all locations are reported on one return.)
3.  Will sales be made from various temporary locations?                Yes   No
4.  Do you ship or deliver merchandise to Kansas customers?                Yes    No
5.  Do you purchase merchandise, equipment, fixtures, and other items outside Kansas for your own use (not for resale) in Kansas on 
which you are not charged a sales tax?      Yes                     No
6.  Estimate your annual Kansas sales or compensating use tax liability:
 $400 and under (annual filer)  $401 - $4,000 (quarterly filer)                   $4,001 and more (monthly filer)
7.  If your business is seasonal, list the months you operate: _______________________________________________________________________________________________________________
8.  Do you perform labor services in connection with the construction, reconstruction, or repair of commercial buildings or facilities?
 Yes      No
9.  Do you sell natural gas, electricity, or heat (propane gas, LP gas, coal, wood) to residential or agricultural customers?                            Yes  No
10. Are you a remote seller? (See instructions)               Yes      No
11. Are you a marketplace facilitator? (See instructions)               Yes  No
12. As a marketplace facilitator, do you wish to report your retailer's compensating use tax collected from direct sales made by you separately 
from the tax you collected from sales you facilitated on behalf of marketplace sellers?                                   Yes  No
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ENTER YOUR EIN: _____________________________________________________        OR                   SSN: _______________________________________________________

PART 6 – WITHHOLDING TAX
1.  Date you began making payments subject to Kansas withholding: ________________________________
2.  Estimate your annual Kansas withholding tax:  $200 and under (annual filer)                    $201 to $1,200 (quarterly filer)
 $1,201 to $8,000 (monthly filer)                $8,001 to $100,000 (semi-monthly filer)          $100,001 and above (quad-monthly filer)
3.  If your withholding reports and returns are prepared by a payroll service, complete the following information about the payroll company:
Name:  _____________________________________________  EIN: ___________________________             Phone:  _________________________________
City: _________________________________________    County: ______________________________         State:  ___________   Zip Code:  _____________
4.  Did you hire a home health provider; commonly referred to as a Financial Management Service (FMS), to report withholding for this 
registration?  No         Yes  If yes, provide name and Employer ID Number (EIN) of the FMS.
Name: ___________________________________________________________________________   EIN: ____________________________

PART 7 – CORPORATE INCOME TAX OR PRIVILEGE TAX
1. Date corporation began doing business in Kansas or deriving income from sources within Kansas: _______________________________
2. Name and EIN you will use to report federal income/expenses (if different than what is reported in PART 3, questions 2 and 6):
Name: ______________________________________________________________________________               EIN: ____________________________________
3. If your business is a financial institution, check the appropriate box:    Bank              Savings and Loan
4. Check type of tax year:  Calendar Year        Fiscal Year              If fiscal year, provide year-end date: Month _______Day  _________
5. If your business is a cooperative or political subdivision, check the appropriate box:         Cooperative     Political Subdivision

PART 8 – LIQUOR ENFORCEMENT TAX
1. Date of first sales of alcoholic liquor: ______________________________________
2. Check type of license:   Retail Liquor Store     Distributor                                 Microbrewery or Microdistillery   Producer
                            Farm Winery/Outlet      Special Order Shipping                      Farmers Market Sales Permit       Other
3.  Will you be selling other goods or services in addition to alcoholic liquor?       Yes       No

PART 9 – LIQUOR DRINK TAX
1. Date of first sales of alcoholic beverages: _________________________________
2. Check type of license:   Class “A” or “B” Club                      Public Venue             Caterer                           Producer
                            Hotel or Hotel/Caterer                     Drinking Establishment   Drinking Establishment/Caterer    Other

PART 10 – CIGARETTE TAX AND CONSUMABLE MATERIAL TAX
1. Do you make retail sales of regular and/or electronic cigarettes over-the-counter, by mail, by phone, or over the internet?   No   Yes
If yes, you must enclose with this application a check or money order for $25 for each location and provide your email or Web page address:
 __________________________________________________________________________________________________________________________________
2. If you sell regular cigarettes (not e-cigarettes), provide the name of your wholesaler(s):  ______________________________________________
3. If you sell electronic cigarettes, provide the name of your wholesaler(s): _____________________________________________________________
4. Will you be the operator of cigarette vending machines?              No   Yes  If yes, enclose form CG-83 listing the machine brand name 
and serial number for each machine, along with the DBA name and location address where each machine will be located. Also enclose 
a check or money order for $25 for each machine.
5. Name of the company/corporation with whom you have a fuel supply agreement/retailing agreement (e.g., Shell, BP, Phillips 66, Conoco):
 __________________________________________________________________________________________________________________________________
6. If you are a distributor or manufacturer of consumable material, or if you are a retailer who sells consumable material on which the 
consumable material tax has not been paid, you must complete and submit form                    EC-1, Application for Consumable Material Tax 
Registration, to the Department of Revenue.
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ENTER YOUR EIN: _____________________________________________________                                   OR           SSN: _______________________________________________________

PART 11 – NONRESIDENT CONTRACTOR (see instructions)
If registering for more than one contract, enclose a separate page for each contract.
1. Total amount of this contract: $ __________________________________
2. Required bond:  $1,000          8% of Contract                                4% of Contract (enclose a copy of the project exemption certificate)
3. List who contract is with:  __________________________________________________________________________________  Phone: __________________________________________________
4. Location of Kansas project (include apartment, suite, or lot number): _______________________________________________________________________________________________
City: ____________________________________________________________   County: ______________________________________________   State: ______________  Zip Code:  ______________________
5. Starting date of contract:  _________________________________________________  Estimated contract completion date: ___________________________
6. Subcontractor’s name (If more than one, enclose an additional page): _____________________________________________________________________________________________
Street Address: ______________________________________________________________ City:  _______________________________________ State: ______________  ZIP Code: ____________________
7. Subcontractor’s EIN:  ______________________________________________________
8. Subcontractor’s portion of contract: $ _____________________________

PART 12 – OWNERSHIP DISCLOSURE AND SIGNATURE STATEMENT
 List ALL owners, partners, corporate officers, and directors. Provide the personal information and signatures of all persons who have 
control or authority over how business funds or assets are spent. If more space is needed, attach additional pages.
Certification: To the best of my knowledge and belief the information on this application is true, correct, and complete. If the business fails 
to report or pay appropriate state taxes, any individual who is responsible for the tax authorizes the Secretary of Revenue or his/her designee 
to research the credit history of the business or that individual.

_______________________________________________________________________________________________________   X ____________________________________________________________________________________
     Printed full proper name of owner, partner, or corporate officer                                      Signature of owner, partner, or corporate officer  Date
SSN:  _______________________________________________________________________________________________     Title: __________________________________________________________________________________
Home address: __________________________________________________________________________________            _______________________________________________________________________________________
                                                                                                           City                                     State     Zip Code
Home phone: _______________________________________  Email: ________________________________________________________________________   Percent of Ownership: ___________________%
Do you have control or authority over how business funds or assets are spent?                              No      Yes
Date that you became the owner, partner, or corporate officer of this business: _____________________________________

_______________________________________________________________________________________________________   X ____________________________________________________________________________________
     Printed full proper name of owner, partner, or corporate officer                                      Signature of owner, partner, or corporate officer  Date
SSN:  _______________________________________________________________________________________________     Title: __________________________________________________________________________________
Home address: __________________________________________________________________________________            _______________________________________________________________________________________
                                                                                                           City                                     State     Zip Code
Home phone: _______________________________________  Email: ________________________________________________________________________   Percent of Ownership: ___________________%
Do you have control or authority over how business funds or assets are spent?                              No      Yes
Date that you became the owner, partner, or corporate officer of this business: _____________________________________

_______________________________________________________________________________________________________   X ____________________________________________________________________________________
     Printed full proper name of owner, partner, or corporate officer                                      Signature of owner, partner, or corporate officer  Date
SSN:  _______________________________________________________________________________________________     Title: __________________________________________________________________________________
Home address: __________________________________________________________________________________            _______________________________________________________________________________________
                                                                                                           City                                     State     Zip Code
Home phone: _______________________________________  Email: ________________________________________________________________________   Percent of Ownership: ___________________%
Do you have control or authority over how business funds or assets are spent?                              No      Yes
Date that you became the owner, partner, or corporate officer of this business: _____________________________________
     Send this form and any payments to: Kansas Department of Revenue, PO Box 3506, Topeka KS 66625-3506 
                                   or FAX to 785-291-3614. For assistance call 785-368-8222.
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