ARIZONA JOINT TAX APPLICATION

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1 ARIZONA JOINT TAX APPLICATION IMPORTANT: Incmplete applicatins WILL NOT BE PROCESSED. All required infrmatin is designated with asterisk * T cmplete this applicatin see attached instructins. Please return Cmplete applicatin with apprpriate license fee(s) t: License & Registratin Sectin, Department f Revenue, PO BOX 29032, Phenix AZ T cmplete this nline, g t Sectin A: Taxpayer Infrmatin (Print legibly r type the infrmatin n this applicatin.) 1. License Type (Check all that apply) * 2. Type f Ownership * Transactin Privilege Tax (TPT) Individual / Sle Prprietrship Sub-Chapter S Crpratin Partnership Assciatin Withhlding/Unemplyment Tax (if hiring emplyees) Prfessinal Limited Liability Trust Use Tax Limited Liability Cmpany Gvernment TPT Fr Cities ONLY Limited Liability Partnership Estate 3. Federal Emplyer Identificatin Number (Required fr Emplyers and Crpratin Jint Venture Entities ther than Sle Prprietrs) r Scial Security Number * State f Inc. Receivership Date f Inc. Tax exempt rganizatins must attach a cpy f the Internal Revenue Service letter f determinatin. 4. Legal Business Name / Owner / Emplying Unit * 5. Business r Ding Business As Name * 8. Mailing Address (Street, City, State, ZIP cde) * 6. Business Phne Number * 7. Fax Number 9. Cuntry 10. Address 11. Is yur business lcated n an Indian Reservatin? Yes If yes, (See fr listing f Reservatins) 12. Physical Lcatin f Business (Street, City, State, ZIP cde) D nt use PO Bx r Rute N. * 13. Cunty Fr additinal business lcatins, cmplete Sectin B Are yu a cnstructin cntractr? * 15. Did yu acquire, r change the legal frm f business f, all r part f an existing business? * Yes (See Bnding Requirements belw) Yes If yes, yu must cmplete the Unemplyment Tax Infrmatin (Sectin D) Bnding Requirements: Prir t the issuance f a Transactin Privilege Tax license, new r ut-f-state cntractrs are required t pst a Taxpayer Bnd fr Cntractrs, unless the Cntractr qualifies fr an exemptin frm the bnding requirement. The primary type f cntracting being perfrmed determines the amunt f bnd t be psted. Bnds may als be required frm applicants wh are delinquent in paying Arizna taxes r have a histry f delinquencies. Fr mre infrmatin n bnding, please see the Taxpayer Bnds publicatin, which is available nline r at the Department f Revenue ffices. 16. Descriptin f Business (Must include type f merchandise sld r taxable activity; fr emplyers, the type f emplyment) * 17. Business Cdes (Include all cdes that apply): See instructins. Cmplete list available at State/Cunty City Additinal Cunty/Regin Indian Reservatin: Cunty/Regin and Indian Reservatin Cdes available at Cunty / Regin City 18. NAICS Cde: (Select at least ne. G t fr a listing f cdes) * 19. Identificatin f Owner, Partners, Crprate Officers, Members / Managing Members r Officials f this emplying unit A. Name (Last, First, MI) * B. Sc. Sec. N. * C. Title * D. % Owned * E. Cmplete Residence Address * F. Phne Number * If the wner, partners, crprate fficers r cmbinatin f partners r crprate fficers, members and/r managing members wn mre than 50% f r cntrl anther business in Arizna, attach a list f the businesses, percentages wned and unemplyment insurance accunt numbers. THIS BOX FOR AGENCY USE ONLY New Change Revise Repen Acct. N. Start S/E Date LIAB LIAB Est. DLN TPT WH

2 Sectin B: Transactin Privilege Tax (TPT) 1. Date Business Started in Arizna * 2. Date Sales Began * Page 2 3. What is yur anticipated annual incme fr yur first twelve mnths f business? 4. TPT Filing Methd 5. Des yur business sell tbacc prducts? 6. Des yur business sell new mtr vehicle tires r vehicles? Cash Receipts Yes If yes, Retailer OR Accrual Distributr Yes (Yu will be required t file a TR-1.) 7. Are yu a seasnal filer? If yes, please check the mnths in which yu intend t d business: Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nv Dec Yes 8. Lcatin f Tax Recrds (Street Address, City, State and ZIP cde) D nt use PO Bx r Rute N. * 9. Name f Cmpany r Persn t Cntact 10. Phne Number Fr additinal lcatins, cmplete the fllwing: (If mre space is needed, please attach additinal sheets) 11. Ding Business As Name fr this Lcatin 12. Phne Number 13. Physical Lcatin Address (D nt use PO Bx r Rute N.) 14. City 17. Ding Business As Name fr this Lcatin 20. Physical Lcatin Address (D nt use PO Bx r Rute N.) 15. Cunty 16. State 17. ZIP cde 19. Phne Number 21. City 22. Cunty 23. State 24. ZIP cde Sectin C: Prgram Cities / License Fees Belw is a list f cities and twns licensed by the Arizna Department f Revenue. City/Twn Cde Fee N. f Ttal City/Twn Cde Fee N. f Ttal City/Twn Cde Fee N. f Ttal Lc Lc Lc Bensn BS 5.00 Bisbee BB 1.00 Buckeye BE 2.00 Bullhead City BH 2.00 Camp Verde CE 2.00 Carefree CA Casa Grande CG 2.00 Cave Creek CK Chin Valley CV 2.00 Clarkdale CD 2.00 Cliftn CF 2.00 Clrad City CC 2.00 Clidge CL 2.00 Cttnwd CW 2.00 Dewey/Humbldt DH 2.00 Duncan DC 2.00 Eagar EG El Mirage EM Ely EL Flrence FL 2.00 Funtain Hills FH 2.00 Frednia FD Gila Bend GI 2.00 Gilbert GB 2.00 Glbe GL 2.00 Gdyear GY 5.00 Guadalupe GU 2.00 Hayden HY 5.00 Hlbrk HB 1.00 Huachuca City HC 2.00 Jerme JO 2.00 Kearny KN 2.00 Kingman KM 2.00 Lake Havasu LH 5.00 Litchfield Park LP 2.00 Mammth MH 2.00 Marana MA 5.00 Maricpa MP 2.00 Miami MM 2.00 Or Valley OR Page PG 2.00 Paradise Valley PV 2.00 Parker PK 2.00 Patagnia PA Paysn PS 2.00 Pima PM 2.00 Pinetp/Lakeside PP 2.00 Presctt Valley PL 2.00 Quartzsite QZ 2.00 Queen Creek QC 2.00 Saffrd SF 2.00 San Luis SU 2.00 Please Nte: City fees are subject t change (g t 4ur website fr updates). Fr cities nt listed abve, please cntact the cities directly. Yur license will nt be issued until all fees are paid. Ttal f City Fees: Sahuarita SA 5.00 Shw Lw SL 2.00 Sierra Vista SR 1.00 Snwflake SN 2.00 Smertn SO 2.00 Suth Tucsn ST 2.00 Springerville SV 5.00 St. Jhns SJ 2.00 Star Valley SY 2.00 Superir SI 2.00 Surprise SP Taylr TL 2.00 Thatcher TC 2.00 Tllesn TN 2.00 Tmbstne TS 1.00 Tusayan TY 2.00 Welltn WT 2.00 Wickenburg WB 2.00 Willcx WC 1.00 Williams WL 2.00 Winkelman WM 2.00 Winslw WS Yungtwn YT Yuma YM 2.00 State Fees $12.00 X Number f Lcatins: TOTAL Fees:

3 Sectin D: Withhlding/Unemplyment Tax Infrmatin 1. Date Emplyees 2. Are yu liable fr Federal Unemplyment Tax? First Hired in Arizna. * Yes If yes, what was the first year f liability? N Year 3. Are individuals perfrming services that are excluded frm withhlding r unemplyment tax? 4. D yu have an IRS Ruling that grants an exclusin 5. D yu have r have yu previusly had an Arizna Unemplyment Tax Number? frm Federal Unemplyment Tax? Yes If yes, attach a cpy f the Ruling Letter. Yes If yes, Business Name Unemplyment Number 6. Recrd f Arizna wages paid by calendar quarter fr current and preceding calendar year. YEAR 1ST QUARTER 2ND QUARTER 3RD QUARTER 4TH QUARTER Yes N If yes, describe the services: Page 3 7. Weekly recrd f number f persns perfrming services in Arizna fr current and preceding calendar year. YEAR JANUARY FEBRUARY MARCH APRIL MAY JUNE YEAR JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER Cmplete this sectin if yu acquired, r changed the legal frm f business f, all r part f an existing Arizna business. 8. Date Acquired r Date 9. Acquired, r Changed Legal Frm f Business f, * 10. Acquired by * If ther, including change Legal Frm f Business All in legal frm f business, changed * Purchase explain: Part If part, t btain an unemplyment tax rate based n the Lease business s previus accunt yu must request it n later than 180 days after the date entered in item 8 f this sectin. See instructins. Other Previus Owner Infrmatin r Previus Legal Frm f Busness Infrmatin (See instructins.) 11. Name(s) f Previus Owner(s) * 12. Business Name f Previus Owner(s) * 13. Current Mailing Address f Previus Owner(s) (Street, City, State, ZIP cde) 14. Current Telephne Number f Previus Owner(s) 15. Unemplyment Accunt Number f Previus Owner(s) Vluntary Electin f Unemplyment Insurance Cverage (subject t Unemplyment Tax Office apprval). 16. The applicant, n behalf f the emplying unit, vluntarily elects beginning January 1 f the current calendar year r the date emplyment started, if later, and cntinuing fr nt less than tw calendar years, t: A. Be deemed an emplyer subject t Title 23, Chapter 4, Arizna Revised Statutes, t the same extent as all ther such emplyers and prvide unemplyment insurance cverage t my wrkers perfrming services defined by law as emplyment, even thugh I have nt met cnditins requiring me t prvide such cverage. B. Extend unemplyment insurance cverage t wrkers referred t in item 2, abve, by having the services they perfrm be deemed t cnstitute. Emplyment by an emplyer subject t Title 23, Chapter 4, A.R.S.

4 Sectin E: AZTaxes.gv Security Administratr (Authrized User) By electing t register fr yu can have nline access t accunt infrmatin, and file and pay Arizna transactin, use, and withhlding taxes. Yu als designate authrized users t access these services. I Elect t Register t use aztaxes.gv t file and pay nline. Page 4 I DO NOT Elect t Register t use aztaxes.gv t file and pay nline. 1. Authrized Users Last Name 2. Authrized Users First Name 3. Authrized Users Title 4. Authrized Users Scial Security Number 5. Authrized Users Address 6. Authrized Users Phne Number Sectin F: Signature(s) by individuals legally respnsible fr the business (required) This applicatin must be signed by either a sle wner, partners, crprate fficer, managing member, the trustee, receiver r persnal representative f an estate. Under penalty f perjury I (we), the applicant, declare that the infrmatin prvided n this applicatin is true and crrect. I (we) hereby authrize the security administratr, if ne is listed in Sectin E, t access the AZTaxes.gv site fr the business identified in Sectin A. This authrity is t remain in full frce and effect until the Arizna Department f Revenue has received written terminatin ntificatin frm an authrized fficer. Type r Print Name Title Signature Date Type r Print Name Title Signature Date THIS APPLICATION MUST BE COMPLETED, SIGNED AND RETURNED AS PROVIDED BY ARS Equal Opprtunity Emplyer/Prgram This dcument available in alternative frmats by cntacting the UI Tax Office.

5 INSTRUCTIONS FOR ARIZONA JOINT TAX APPLICATION IMPORTANT: Yu must cmplete each f the fllwing sectins r yur applicatin will be returned Page 5 Fr licensing questins n Transactin Privilege, Withhlding r Use Tax (Department f Revenue) call (602) Fr Unemplyment Tax (Department f Ecnmic Security) call (602) r USE THIS APPLICATION TO: License New Business: A new business with n previus wners. Change Ownership: If acquiring r succeeding t all r part f an existing business r changing the legal frm f yur business (sle prprietrship t crpratin, etc.). If yu need t update a license, add a business lcatin, get a cpy f yur license r make ther changes: Cmplete a Transactin Privilege Tax License Update frm and include fees f $12 per lcatin. Sectin A: TAXPAYER INFORMATION 1. LICENSE TYPE Transactin Privilege Tax (TPT): Anyne invlved in an activity taxable under the TPT statutes must apply fr a TPT License befre engaging in business. Fr TPT, yu are required t btain and display a separate license certificate fr each business r rental lcatin. This may be accmplished in ne f the fllwing ways: Each lcatin may be licensed as a separate business with a separate license number fr purpses f reprting transactin privilege and use taxes individually. Therefre a separate applicatin is needed fr each lcatin. Multiple lcatins may be licensed under a cnslidated license number, prvided the wnership is the same, t allw filing f a single tax return. If applying fr a new license, list the varius business lcatins as instructed belw. If already licensed and yu are adding lcatins, d nt use this applicatin t cnslidate an existing license. Please submit update frm. Withhlding & Unemplyment Taxes: Emplyers paying wages r salaries t emplyees fr services perfrmed in the State must apply fr a Withhlding number & Unemplyment number. Use Tax: Out-f-state vendrs (that is, vendrs with n Arizna lcatin) making direct sales int Arizna must btain a Use Tax Registratin Certificate. In-state vendrs making ut-f-state purchases fr their wn use (and nt fr resale) must als btain the Use Tax Registratin Certificate. TPT fr cities nly: This type f license is needed if yur business activity is subject t city TPT that is cllected by the state, but the activity is nt taxed at the state level. Many f the larger cities in Arizna administer and cllect their wn privilege taxes. Please cntact thse cities directly t btain infrmatin regarding licensing requirements. 2. TYPE OF OWNERSHIP Check as applicable. A crpratin must prvide the state and date f incrpratin. 3. Enter yur Federal Emplyer Identificatin number. Taxpayers are required t prvide their taxpayer identificatin number (TIN) n all returns and dcuments. A TIN is defined as the federal emplyer identificatin number (EIN), r scial security number (SSN) depending upn hw incme tax is reprted. The EIN is required fr all emplyers. A penalty f $5 will be assessed by the Department f Revenue fr each dcument filed withut a TIN. 4. Enter the Legal Business Name f the Owner r Emplying Unit (name f crpratin as listed in its articles f incrpratin, r individual & spuse, r partners, r rganizatin wning r cntrlling the business). 5. Enter the name f the Business/DBA (ding business as) Name. If same as abve, enter same. 6. Enter the business telephne number including area cde. 7. Enter the fax number including area cde. 8. and 9. Enter mailing address where all crrespndence is t be sent. Yu may use yur hme address, crprate headquarters, r accunting firm s address, etc. If mailing address differs fr licenses (fr instance withhlding and unemplyment insurance), please use cver letter t explain. 10. Enter the address (ptin) fr the business r cntact persn. 11. See fr listing f reservatin cdes if yur business is lcated n an Indian Reservatin. 12. and 13. Enter the physical lcatin f business including cunty. This can nt be a PO Bx r Rute Number. 14. If yu are a cnstructin cntractr, read the bnding requirements carefully. 15. If yu answered yes, yu must cmplete Sectin D. 16. Describe the majr business activity: principal prduct yu manufacture, cmmdity sld, r services perfrmed. Yur descriptin f the business is very imprtant because it determines yur transactin privilege tax rate and prvides a basis fr state ecnmic frecasting. 17. The tables prvided n page 7 cntain sme f the Business Cdes fr the State f Arizna, cunties and cities. A cmplete listing is available at 18. Enter the Nrth American Industries Classificatin System (NAICS) cde identified fr yur business activity. 19. Identify the wners f the business. Enter as many as applicable; attach a separate sheet if additinal space is needed. Sectin B: TRANSACTION PRIVILEGE TAX (TPT) 1. Enter the date the business started in Arizna. 2. Enter date sales began in Arizna, r estimate when yu plan t begin selling in Arizna. 3. Enter the amunt f Transactin Privilege Tax incme yu can reasnably expect t generate in yur first twelve mnths f business. Yu will be set up fr mnthly filing unless yur anticipated annual incme will result in a tax liability f less than $1,250, which may qualify yu fr quarterly filing. 4. Cash/Accrual Methds: Cash methd requires the payment f tax based n sales receipts actually received during the perid cvered n the tax return. When filing under the

6 accrual methd, the tax is calculated n the sales billed rather than actual receipts. 5. Cmplete as indicated. 6. Sellers f new mtr vehicles and mtr vehicle tires in the state, fr n-rad use, are required t reprt and pay waste tire fees t the Department f Revenue. By checking the bx, yu will receive frm TR-1 n a quarterly basis. 7. If yur business is seasnal r a transient vendr, indicate the mnths in which yu intend t d business. 8. thrugh 10. Indicate the physical lcatin f yur tax recrds, the cntact persn and their phne number. This can nt be a PO Bx r Rute Number. 11. thrugh 24. If yu have additinal business lcatins, cmplete this sectin. If mre space is necessary, attach additinal sheets. Sectin C: PROGRAM CITIES / LICENSE FEES There are n fees fr Withhlding, Unemplyment, r Use Tax registratins. T calculate the fees fr TPT licenses, multiply the number f lcatins in the state by $12. T calculate the city fees, use the listing f prgram cities in Sectin C. First, indicate the number f businesses r physical lcatins fr each f the cities fr which the Department f Revenue licenses and cllects. Then multiply by the city fee fr each city in which yu will d business. Add the clumns t determine the ttal city fees. Fill in the ttals fr state fees and city fees n the applicatin frm and ttal t determine the amunt due. Make checks payable t the Arizna Department f Revenue. Be sure t return the city fees sheet with yur applicatin. T btain licensing fr cities nt listed n the frm, please cntact the city directly. Sectin D: WITHHOLDING/UNEMPLOYMENT TAX INFO 1. thrugh 7. Cmplete as indicated. 8. Enter the date yu acquired the previus wner s business r changed the legal frm f yur existing business (sle prprietr t crpratin, etc). 9. Indicate whether yu acquired r changed all r nly part f the existing Arizna business. If part, t btain an unemplyment tax rate based n the business s previus accunt, yu must request it n later than 180 days after the date f acquisitin r legal frm f business change; cntact the Unemplyment Tax Office Experience Rating Unit fr an Applicatin & Agreement fr Severable Prtin Experience Rating Transfer (frm UC-247; printable versin available nline at 10. Indicate the manner in which yu became the new wner r peratr f this business r, if yu merely changed the legal frm f yur existing business, check Other and explain, fr example, Changed sle prprietrship t crpratin thrugh 12. Cmplete as indicated if yu acquired an existing business r, if yu merely changed the legal frm f yur existing business, prvide infrmatin n yur business under its previus legal frm. Page thrugh 15. Cmplete as indicated if yu knw the previus wner s infrmatin r, if yu merely changed the legal frm f yur existing business, prvide infrmatin n yur business under its previus legal frm. 16. Once certain cnditins are met, the law requires emplyers t prvide unemplyment insurance cverage t their wrkers, but nly fr services the law defines as emplyment. Check Bx A if yu believe yu have nt met such cnditins and yu vluntarily elect t prvide such cverage anyway. Check Bx B if yu vluntarily elect t cver yur wrkers wh perfrm services the law excludes frm its definitin f emplyment and wh are excluded frm cverage therwise. Leave bxes blank if neither chice applies. Please nte: If yu check ne r bth bxes, then yur signature(s) in Sectin F cnfirm(s) yur vluntary electin t assume liability fr the extent f unemplyment cverage yur selectin indicates fr at least tw calendar years, and yu will nt be permitted t challenge this electin at a later date if it is apprved. T learn mre, please refer t the Emplyers Handbk r Guide t Arizna Emplyment Tax Requirements available nline at r cntact the Unemplyment Tax Office Emplyer Status Unit. Sectin E: AZTaxes.gv AUTHORIZED USER INFO 1. thrugh 6. Cmplete this sectin if yu wuld like t designate a security administratr fr yur nline services at gv. The authrized individual will have full access t tax accunt infrmatin and will add r delete users and grant user privileges t view tax accunt infrmatin, file tax returns, and remit tax payments n behalf f the business identified in Sectin A. The name and address f the administratr are required fr registratin. Sectin F: SIGNATURES The applicatin must be signed nly by individuals legally respnsible fr the business, nt agents r representatives.

7 State/Cunty Business Cdes Cdes Taxable Activities Cdes Taxable Activities Cdes Taxable Activities 002 Mining - Nnmetal 013 Cmmercial Lease 033 Telecmmunicatins Devices 004 Utilities 014 Persnal Prperty Rental 041 Municipal Water 005 Cmmunicatins 015 Cntracting - Prime 049 Jet Fuel Tax 006 Transprting 017 Retail 051 Jet Fuel Use Tax 007 Private (Rail) Car 019 Severance -Metalliferus Mining 053/055 Rental Car Surcharge Jet Fuel Tax > 10 millin 008 Pipeline 023 Recreatinal Vehicle Surcharge 056 gallns 009 Publicatin 025 Transient Ldging 129 Use Tax Direct Payments Rental Car Surcharge Jb Printing 026 Use Tax - Utilities 153 Stadium 011 Restaurants and Bars 029 Use Tax Purchases Telecmmunicatins 012 Amusement 030 Use Tax frm Inventry 912 E911 Prepaid Wireless Page 7 City Business Cdes Cdes Taxable Activities Cdes Taxable Activities Cdes Taxable Activities 004 Utilities 019 Severance -Metalliferus Mining 062 Retail Sales Fd fr Hme Cnsumptin 005 Cmmunicatins 020 Timbering & Other Extractin 111 Additinal Restaurants & Bars Shrt Term Mtr Vehicle 006 Transprting 027 Manufactured Buildings 114 Rental 009 Publicatin 029 Use Tax 116 Feed Whlesale 010 Jb Printing 030 Use Tax frm Inventry 144 Htel/Mtel (additinal tax) 011 Restaurants and Bars 037 Cntracting - Owner Builder 213 Cmmerical Rental, Licensing fr Use 012 Amusement 040 Rental Occupancy 214 Rental, Leasing and Licensing fr Use f Tangible Persnal Prperty 015 Cntracting - Prime 044 Htels 244 Ldging-Extended Stay Cmmerical Lease (additnal 016 Cntracting Spec Builder 049 Jet Fuel Tax 313 tax) 017 Retail 051 Jet Fuel Use 485 Wastewater Utility 018 Advertising 056 Jet Fuel Tax > 10 millin gallns

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