Form SFN60422 "Application for Alcoholic Beverage Logistics Shipper License" - North Dakota

What Is Form SFN60422?

This is a legal form that was released by the North Dakota Office of State Tax Commissioner - a government authority operating within North Dakota. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2013;
  • The latest edition provided by the North Dakota Office of State Tax Commissioner;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form SFN60422 by clicking the link below or browse more documents and templates provided by the North Dakota Office of State Tax Commissioner.

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Download Form SFN60422 "Application for Alcoholic Beverage Logistics Shipper License" - North Dakota

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APPLICATION FOR ALCOHOLIC BEVERAGE
LOGISTICS SHIPPER LICENSE
OFFICE OF NORTH DAKOTA STATE TAX COMMISSIONER
SFN 60422 (7-13)
For Calendar Year
New License
Renewal
ND License Number (renewals only)
Legal Name
DBA (if applicable)
Federal Employee Identification Number
Physical Address
City
State
ZIP Code
Mailing Address
State
ZIP Code
City
Contact Person
Telephone Number
Email Address
Change of Any Information From Previous Application
Annual Fee: $100.00
The state of domicile for this business is _______________________.
Is the business currently licensed in the state of domicile?
No
Yes
If yes, enter type of license ______________________________, license number _________________
and expiration date __________________________.
Have you ever had any type of license suspended or revoked in any state?
If yes, list where and when _____________________________________________________________
No
Yes
Agreement to Electronically File
The Tax Commissioner agrees to authorize the above named company to electronically file the tax reports and schedules
as required under North Dakota Century Code chs. 5-01 and 5-03. The signature of the company affixed to this
application shall be deemed to appear on such electronically filed reports and schedules, as if actually so appearing. All
reports and schedules filed electronically pursuant to this agreement are deemed by the company to be truthful, accurate
and complete statements made under penalty of perjury, and shall be in form compatible with the Tax Commissioner's
equipment, software, and facilities. Any electronic filing not in conformity with the requirements specified herein shall be
deemed a failure to file such reports and schedules and company shall be subject to all applicable penalties prescribed by
law.
I declare under the penalties of North Dakota Century Code § 12.1-11-02, which provides for a Class A misdemeanor for
making a false statement in a governmental matter, that this application has been examined by me and to the best of my
knowledge and belief is complete, correct, and true.
Name of Owner or Authorized Officer (print or type)
Signature of Owner or Authorized Officer
Title
Date
Please send application and license fee to:
For Tax
Office of State Tax Commissioner
Department
Sales and Special Taxes Compliance Section
Use Only
600 E. Boulevard Ave. Dept. 127
Bismarck, ND 58505-0599
Phone: (701) 328-2702
APPLICATION FOR ALCOHOLIC BEVERAGE
LOGISTICS SHIPPER LICENSE
OFFICE OF NORTH DAKOTA STATE TAX COMMISSIONER
SFN 60422 (7-13)
For Calendar Year
New License
Renewal
ND License Number (renewals only)
Legal Name
DBA (if applicable)
Federal Employee Identification Number
Physical Address
City
State
ZIP Code
Mailing Address
State
ZIP Code
City
Contact Person
Telephone Number
Email Address
Change of Any Information From Previous Application
Annual Fee: $100.00
The state of domicile for this business is _______________________.
Is the business currently licensed in the state of domicile?
No
Yes
If yes, enter type of license ______________________________, license number _________________
and expiration date __________________________.
Have you ever had any type of license suspended or revoked in any state?
If yes, list where and when _____________________________________________________________
No
Yes
Agreement to Electronically File
The Tax Commissioner agrees to authorize the above named company to electronically file the tax reports and schedules
as required under North Dakota Century Code chs. 5-01 and 5-03. The signature of the company affixed to this
application shall be deemed to appear on such electronically filed reports and schedules, as if actually so appearing. All
reports and schedules filed electronically pursuant to this agreement are deemed by the company to be truthful, accurate
and complete statements made under penalty of perjury, and shall be in form compatible with the Tax Commissioner's
equipment, software, and facilities. Any electronic filing not in conformity with the requirements specified herein shall be
deemed a failure to file such reports and schedules and company shall be subject to all applicable penalties prescribed by
law.
I declare under the penalties of North Dakota Century Code § 12.1-11-02, which provides for a Class A misdemeanor for
making a false statement in a governmental matter, that this application has been examined by me and to the best of my
knowledge and belief is complete, correct, and true.
Name of Owner or Authorized Officer (print or type)
Signature of Owner or Authorized Officer
Title
Date
Please send application and license fee to:
For Tax
Office of State Tax Commissioner
Department
Sales and Special Taxes Compliance Section
Use Only
600 E. Boulevard Ave. Dept. 127
Bismarck, ND 58505-0599
Phone: (701) 328-2702