Form TA-1
Application for Original Registration
Rev. 12/02
Massachusetts
Department of
Revenue
Check As Many As Apply
1. A |
1. |
|
Employer under the Income Tax Withholding Law (payroll tax) |
D |
|
Governmental or Charitable Exempt Purchaser |
|
|
|
2. |
|
Withholding for Pension Plans, Annuities and Retirement |
E |
|
Chapter 180 Organization Selling Alcoholic Beverages |
|
|
|
|
|
|
Distributions |
F |
|
Use Tax Purchaser |
|
|
|
|
|
|
|
|
B |
1. |
|
Sales/Use Tax on Goods Vendor |
G |
|
Boston Sightseeing Tour Surcharge |
|
|
|
|
|
2. |
|
Sales/Use Tax on Telecommunications Services Vendor |
H |
|
Boston Vehicular Rental Transaction Surcharge |
|
|
|
|
|
|
|
3. |
|
Meals Tax on Food and All Beverages |
I |
|
Parking Facilities Surcharge in Boston, Springfield |
|
|
|
|
|
|
|
4. |
|
Purchasing in MA for Out-of-State Resale Only |
|
|
and/or Worcester |
|
|
|
|
|
|
|
C |
|
|
Room Occupancy Excise |
J |
|
Cigar and Smoking Tobacco Excise |
|
|
|
|
|
Note: If you are selling cigarettes at retail, see instructions.
Federal Identification number
Principal Place of Business
Owner, partnership or legal corporate name
Name (cont’d.)
Number and street
City or town
(Area code) Telephone number
General Information. If a corporation, trust, association, fiduciary, or partnership — you must complete Schedule TA-3.
11.Indicate type of organization:

Corporation 
Trust or association
Sole proprietor
Fiduciary 
Partnership 

Other (specify):
12.Indicate type of business:
|
|
|
Retail trade |
|
|
Wholesale trade |
|
|
Manufacturing |
|
Construction |
|
|
Governmental |
|
|
Finance |
|
Real estate |
|
|
Service |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Other (specify): |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
13. Describe nature of business: |
|
|
|
|
|
|
|
|
|
|
|
|
14. |
Business activity code |
|
|
|
|
|
|
|
|
|
15. Check applicable box: |
|
Profit |
|
Non-profit |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
16. |
If subsidiary corporation |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Name of parent corporation |
|
|
|
|
|
|
|
|
|
|
|
|
|
Federal Identification number |
|
|
|
|
|
|
|
|
|
|
❿ |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
17. |
If sole proprietor |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Name of owner |
|
|
|
|
|
|
|
|
|
|
|
|
|
Social Security number |
|
(sole owner) |
|
|
|
|
❿ |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
18. Reason for applying: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Started new business |
|
Purchased existing business — enter name, address, and Federal |
|
Federal Identification number |
|
|
|
|
|
|
|
|
|
|
|
|
|
Identification number of previous owner |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Federal Identification number |
|
|
|
|
|
Organizational change — Federal Identification number and close date of previous organization must be |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
entered, or application will be returned. |
|
Other (attach explanation) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Mo |
Day |
|
Yr |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Background Information |
Close date: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
19.Are any Massachusetts tax returns due or any Massachusetts taxes owed by your firm?
Yes
No. If yes, please explain:
20.Have you ever been issued a Certificate of Registration that was later revoked?
Yes
No. If yes, please explain:
Exempt Organizations
21.If you are applying for exempt purchaser status, be sure to include a copy of your IRS letter of exemption under Section 501(c)(3) of the Internal Revenue Code. Subordinate organizations covered under an IRS group exemption letter should include a copy of the group exemption ruling and a copy of the organization’s directory page listing the organization as an approved subordinate. Both of the questions below must be answered.
A. Are you exempt from paying U.S. income taxes?
Yes
No. B. Are you exempt from paying local property taxes?
Yes
No.
Location of business |
Federal Identification number |
|
|
|
|
22.Trade name
Trade name (cont’d.)
23.Number and street (PO box is not acceptable)
24. |
City or town |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
25. |
State |
26. |
Zip |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
— |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
27. |
(Area code) Telephone number |
|
|
|
28. |
Send certificate to: |
|
Principal place of business |
|
Location of business. |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
( |
|
) |
|
|
|
— |
|
|
|
|
29. |
Send tax forms to: |
|
Principal place of business |
|
Location of business |
|
Other. |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
If “Other,” complete Schedule TA-4.
Convention Center Financing District
30.Check here if your business location is within a Convention Center Financing District:
(see pages 24–26 of instructions).
31.Check here if your business location is within a hotel, motel or other lodging establishment in Boston or Cambridge: 
Filing Frequencies
32. |
Is this location seasonal? (See instructions) |
|
|
Yes |
|
|
No. |
|
|
|
|
33. Indicate 12-month estimate of tax to be withheld, collected or |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
If “yes,” check month(s) or partial month(s) business operates. |
|
|
|
|
|
|
paid for each applicable tax. Check the appropriate box(es). |
|
Check month(s) |
Jan |
Feb |
Mar |
Apr |
May |
|
Jun |
|
Jul |
|
Aug |
Sep |
Oct |
Nov |
Dec |
Check appropriate box |
|
$0 – $100 |
$101– $1,200 |
$1,201–$25,000 |
over $25,000 |
|
Withholding |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Withholding |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Sales/Use on Goods |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Check appropriate box(es) |
|
|
|
$0 – $100 |
|
|
$101– $1,200 |
over $1,200 |
|
Sales/Use on |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Sales/Use on Goods |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Telecom. Services |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Sales/Use on Telecom. Services |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Meals |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Meals |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Room Occupancy |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Room Occupancy |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Use Tax Purchaser |
|
|
|
|
|
|
|
|
|
|
|
|
|
Tax Type Information |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Withholding |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
34. |
Date you were first required to withhold |
|
Mo |
|
|
Day |
|
Yr |
|
|
|
|
|
35. Number of employees |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
taxes at this location. |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
in Massachusetts: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Sales/Use Tax on Goods |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
36. |
Date you were first required to collect sales/use tax at this location. |
|
Mo |
|
Day |
|
Yr |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Sales/Use Tax on Telecommunications Services |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
37. |
Date you were first required to collect sales/use tax on telecommunications services at this location. |
Mo |
Day |
|
Yr |
|
|
|
|
|
Meals Tax on Food and All Beverages |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
38. |
Check if you serve: |
|
Food |
|
Beer |
|
|
Wine |
|
|
|
Alc. bev. |
|
|
|
|
39. Check if food/beverage vending machine: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
40. |
Date you were first required to collect meals tax. |
|
|
Mo |
|
|
Day |
Yr |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
41. Name and address
on liquor license42. Seating capacity: at this location.
Room Occupancy
43. |
Date you were first required to collect room occupancy tax. |
|
Mo |
Day |
Yr |
|
|
44. |
|
Locality code |
45. |
Number of rooms: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Use Tax Purchaser |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
46. |
Date you were first required to pay use tax. |
Mo |
|
Day |
|
|
Yr |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Convention Center Financing Surcharges |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
47. |
Date you were first required to collect: a. Boston Sightseeing Tour Surcharge. |
Mo |
Day |
|
Yr |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
b. Boston Vehicular Rental Transaction Surcharge. |
Mo |
|
Day |
|
Yr |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
c. Parking Facilities Surcharge in Boston, Springfield and/or Worcester.
Cigar and Smoking Tobacco Excise
48. Date you were first required to collect cigar and smoking tobacco excise. |
Mo |
Day |
Yr |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Mail to: Massachusetts Department of Revenue, Data Integration Bureau, PO Box 7022, Boston, MA 02204.
I hereby certify that the statements made herein have been examined by me and are, to the best of my knowledge and belief, true and correct. Signed under the pains and penalties of perjury. The signing of this application is evidence that you may be individually and personally responsible for any sums required to be paid to the Commonwealth, under MGL, Chapters 62B, Sec. 5; 64G, Sec. 7B; 64H, Sec. 16 and 64I, Sec. 17.