FOR OFFICE USE ONLY
                                     State of Rhode Island
                                        Division of Taxation                                                                   PERMIT #________________________
                                        One Capitol Hill    STE 36
                                          Providence, RI 02908-5829
                                                            WWW.TAX.RI.GOV

 BUSINESS APPLICATION and REGISTRATION 
Fees and Instructions:  Sales                                   if YES                AND
permit is renewable at fiscal year 
      ending June 30th                                          Include          Complete          Additional
                                        Yes    No       Fee:                     Sections:         Information
Do you have employees working in RI?                    None                     A B C D E
Do you have RI Withholding?                             None                     A B C E
Do you lease employees in RI?                           None                     A B C D E
Do you make sales at retail?                            $10.00                   A B E 
(A separate permit & fee is required for each location.)
Sales Tax liability greater than $200 per mo.?          None                     If unknown, check NO.
                                                                
Will you be selling:                                            
                           Gasoline -                   $5.00                    Fee is for filling station license.
               Beverages or food -                      $25.00                   Fee is for litter permit. (Renewable on December 31st)
                             Liquor -                   None                     License from city or town is required.
 Cigarettes/Tobacco/Other Tobacco -                     $25.00                   Each cigarette vending machine requires a separate license and fee.
                Motor Vehicles -                        None                     If yes, MV Dealer license # _____________(required).
      Motor Vehicles leasing -                          None                     If yes, MV Lease license # _____________(required).
      Rental of room(s)/home(s) -                       None                     ** Type of Rental:              Residential Dwelling Rental               Room Rental
Prepaid wireless phone cards -                          None                     Product?
                             Other -
                                        Total Fees enclosed                               ** If multiple locations, complete the Multi-Location City/Town Breakdown Page
                                                                
Date business will commence in this state?                                     Seasonal operation?                  Is application for a temporary event?________
The following codes can be found on INSTRUCTION SHEET 1.                                      (months opened)       Date(s) of event?______________________
Location Code #                                         Business Code #
Section A:  Type or Print Name, Mailing Address and Tax Identification Number
TYPE OF ENTITY:         SOLE OWNER        PARTNERSHIP            CORPORATION                       OTHER      Please specify:  __________________________________
                LIMITED LIABILITY COMPANIES:                          LLC- SOLE PROPRIETOR                 LLC-PARTNERSHIP                          LLC- CORPORATION
Name (Employer, Business, Corporation or Owner)                                                    RI Employment Registration #(if assigned) Business Phone #

Business name (if different from above)                                                            Federal Employer Ident. #(if assigned)                 Sales Tax Permit #(if assigned)

Mailing Address No and Street or P.O BOX (include apt. office or unit#, if any)  City or Town            State                 Zip-Code      State and Date of Incorporation

Actual Rhode Island Location No. and Street (include apt. office or unit #, if   City or Town            State                 Zip Code      Is any other license or permit required?
any)  CANNOT ACCEPT PO BOX #
                               
IF MORE THAN (1) LOCATION, PLEASE COMPLETE PART D-2 ON THE BACK OF THIS FORM                       Name & Sales Permit # of former owner (if not applicable write N/A)
      
Provide a name, address and telephone number of person(s) in charge of Sales and Payroll Records.

                                                                                                                                             (           )
Name                                                    Street                   City                    State                 Zip Code      Telephone number
Section B: Type or Print Name, Social Security Number, Home Address, Title of Owner, each Partner, or each Corporate Officer
Name                                                           Social Security #                   Title                                     Telephone Number

Street Address                                                 City or Town                                         State                    Zip Code

Name                                                           Social Security #                   Title                                     Telephone Number

Street Address                                                 City or Town                                         State                    Zip Code

Form BAR    REVD 07/14/2015

Section C: Payroll Information
Amount of RI withholding taxes you expect to withhold 
from employees each month.                            Filing Status will be Number of employees
$24,000 or more                                           Daily
$600 or more but less than $24,000                    Quarter-Monthly       First date wages paid in RI                                                                                      
$50 or more but less than $600                            Monthly
Less than $50.00                                          Quarterly         Are you - Non-Profit_____Religious_____IRS Code 501-C-3_____
If any part of the business or its assets were acquired,  please enter the date of acquisition, name, address and, if known, RI Employment Registration number of the former owner.
Date of Acquisition                                                              RI Employment Registration #
                               month          day     year
Name of former owner                                                        Trade Name

Street Address                                                              City      State                                                                                        Zip Code

If any employees were acquired from that business, please enter the number of employees acquired.
If you are a sole owner or partnership that is incorporating, state the name and address of the former business. 
Name                                                      Address

Section D Industry Description
D-1: Detailed information about your business is required in order to assign the correct industrial classification.  In the space below describe your most important business
 activities, goods, products or services in Rhode Island as though you were telling a prospective employee what you do.  Please provide the approximate 
percentage of sales or revenues resulting from each product or service. The total of percentages should equal 100%. If you have any questions regarding
this section, please refer to Instruction Sheet 2 or call the Rhode Island Department of Labor & Training's Labor Market Information unit
 at (401) 462-8760 for assistance.

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D-2 Establishment Locations:  If you operate your business at more than one location in Rhode Island, please list the street address, city and zip code for each RI location
 and the approximate employment for each location. If the business activities of any establishment differ from the above, please tell us the products or services of differing location.
Street                                                    Town    Zip Code            Employees                                                                                    Activity

Section E: Certification and Signature (Must be signed)
The undersigned certifies that the information given on this form is true and correct to the best of his or her knowledge and belief.
Date             Signature(s) of Applicant(s)                                    Print Name and Title

Form BAR    REVD 07/14/2015

                                                                   INSTRUCTION SHEET 1
                                            Sales Tax and Litter Permits must be renewed annually.
                                                    LOCATION CODES FOR RHODE ISLAND CITIES AND TOWNS
BARRINGTON         01      CUMBERLAND            08       JAMESTOWN                 15      NEW SHOREHAM                          22            RICHMOND                 29      WESTERLY                               36
BRISTOL            02      EAST GREENWICH        09       JOHNSTON                  16      NORTH KINGSTOWN                       23            SCITUATE                 30      WEST GREENWICH                         37
BURRILLVILLE       03      EAST PROVIDENCE       10       LINCOLN                   17      NORTH PROVIDENCE                      24            SMITHFIELD               31      WEST WARWICK                           38
CENTRAL FALLS      04      EXETER                11       LITTLE COMPTON            18      NORTH SMITHFIELD                      25            SOUTH KINGSTOWN          32      WOONSOCKET                             39
CHARLESTOWN        05      FOSTER                12       MIDDLETOWN                19      PAWTUCKET                             26            TIVERTON                 33      OUT OF STATE                           40
COVENTRY           06      GLOCESTER             13       NARRAGANSETT              20      PORTSMOUTH                            27            WARREN                   34
CRANSTON           07      HOPKINTON             14       NEWPORT                   21      PROVIDENCE                            28            WARWICK                  35
                                                          BUSINESS CODES FOR PRINCIPAL BUSINESS ACTIVITY
These authority titles and definitions are based, in general, on the Standard Industrial Classification System authorized by Regulatory and Statistical Analysis Division, Office of Information and Regulatory Affairs,
Office of Management and Budget, to classify enterprises by type of activity in which they are engaged.  Using the list below, enter on the Application Form, the code number of the specific industry group from which
the largest percentage of "total receipts" is derived.  "Total receipts" means gross receipts plus all other income.
CODE                                        Retail Trade - Selling Goods to Individuals                             Finance, Insurance, Real Estate,                7732 Employment agencies and personnel supply
Construction                                and Households                                                          and Related Services                            7799 Consumer credit reporting and collection
0018 Operative builders(for own account)    3012 Selling door-to-door, by telephone or party plan,                  5520 Real estate agents or brokers                   services
     GENERAL CONTRACTORS                         or from mobile unit                                                5579 Real estate property managers              7856 Mailing, reproduction, commercial arts and
0034 Residential building                   3038 Catalog or mail order                                              5710 Subdividers and builders, except                photography, and stenographic services
0059 Nonresidential building                3053 Vending machine selling                                                 cemeteries                                 7872 Computer programming, processing, data
0075 Highway and street construction        Selling from Showroom, Store, or other                                  5538 Operators and lessors of buildings,             preparation, and related services
3889 Other heavy construction (pipe laying, Fixed  Location                                                              including residential                      7922 Computer repair, maintenance, and leasing
     bridge construction, etc.) Building         Food, beverages, and drugs                                         5553 Operators and lessors or other             7773 Equipment rental and leasing 
     trade contractors, including repairs   3079 Eating places (meals or snacks)                                         real property                                   (except computer or automotive)
0232 Plumbing, heating, air conditioning    3086 Catering services                                                  5702 Insurance agents or brokers                7914 Investigative and protective services
0257 Painting and paper hanging             3095 Drinking places (alcoholic beverages)                              5744 Other insurance services                   7880 Other business services
0273 Electrical work                        3210 Grocery stores (general line)                                      6064 Security brokers and dealers                               Personal services
0299 Masonry, dry wall, stone, tile         0612 Bakeries selling at retail                                         6080 Commodity contracts brokers and            8110 Beauty shops (or beautician)
0414 Carpentering and flooring              3236 Other food stores (meat, produce, candy, etc.)                          dealers, and security and commodity        8318 Barber shop (or barber)
0430 Roofing, siding, and sheet metal       3251 Liquor stores                                                           exchanges                                  8334 Photographic portrait studios
0455 Concrete work                          3277 Drug stores                                                        6130 Investment advisors and services           8532 Funeral services and crematories
0885 Other building trade contractors            Automotive and service stations                                    6148 Credit institutions and mortgage bankers   8714 Child day care
     (excavation, glazing, etc.)            3319 New car dealers (franchised)                                       6155 Title abstract offices                     8730 Teaching or tutoring
Manufacturing, including                    3335 Used car dealers                                                   5777 Other finance and real estate              8755 Counseling (except health practitioners)
Printing and publishing                     3517 Other automotive dealers (motorcycles,                             Transportation, Communications,                 8771 Ministers and chaplains
0638 Food products and beverages                 recreational vehicles, etc.)                                       Public Utilities, and Related Services          6882 Other personal services
0653 Textile mill products                  3533 Tires, accessories, and parts                                      6114 Taxicabs                                        Automotive services
0679 Apparel and other textile products     3558 Gasoline service stations                                          6321 Bus and limousine transportation           8813 Automotive rental or leasing, without driver
0695 Leather, footwear, handbags, etc.           General merchandise, apparel, and furniture                        6361 Other highway passenger transportation     8839 Parking, except valet
0810 Furniture and fixtures                 3715 Variety stores                                                     6338 Trucking (except trash collection)         8953 Automotive repairs, general and specialized
0836 Lumber and other wood products         3731 Other general merchandise stores                                   6395 Courier or package delivery services       8896 Other automotive services (wash, towing, etc.)
0851 Printing and publishing                3756 Shoe stores                                                        6510 Trash collection without own dump          Miscellaneous repair, except computers
0877 Paper and allied products              3772 Men's and boys' clothing stores                                    6536 Public warehousing                         9019 TV and audio equipment repair
1032 Stone, clay, and glass products        3913 Women's ready-to-wear stores                                       6551 Water transportation                       9035 Other electrical equipment repair
1057 Primary metal industries               3921 Women's accessory and specialty stores                             6619 Air transportation                         9050 Reupholstery and furniture repair
1073 Fabricated metal products                   and furriers                                                       6635 Travel agents and tour operators           2881 Other equipment repair
1099 Machinery and machine shops            3939 Family clothing stores                                             6650 Other transportation services                      Medical and health services
1115 Electric and electronic equipment      3954 Other apparel and accessory stores                                 6676 Communication services                     9217 Offices and clinics of medical doctors (MOs)
1883 Other manufacturing industries         3970 Furniture stores                                                   6692 Utilities including dumps, snowplowing,    9233 Offices and clinics of dentists
Mining and Mineral Extraction               3996 TV, audio, and electronics                                              road clearing, etc.                        9258 Osteopathic physicians and surgeons
1511 Metal mining                           3988 Computer and software stores                                       Services (Personal, Professional,               9241 Podiatrists
1537 Coal mining                            4119 Household appliance stores                                         and Business Services                           9274 Chiropractors
1552 Oil and gas                            4317 Other home furnishing stores (china, floor                         Hotels and other lodging places                 9290 Optometrists
1719 Quarrying and nonmetallic mining            coverings, etc.)                                                   7096 Hotels, motels, and tourist homes          9415 Registered 
Agricultural Services, Forestry,            4333 Music and record stores                                            7211 Rooming and boarding houses                9431 Other health practitioners
Fishing                                          Building, hardware, and garden supply                              7237 Camps and camping parks                    9456 Medical and dental  laboratories
1933 Crop services                          4416 Building materials dealers                                              Laundry and cleaning services              9472 Nursing and personal care facilities
1958 Veterinary services, including pets    4432 Paint, glass, and wallpaper stores                                 7419 Coin-operated laundries and dry cleaning 9886   Other health services
1974 Livestock breeding                     4457 Hardware stores                                                    7435 Other laundry, dry cleaning, and garment        Amusement and recreational services
1990 Other animal services                  4473 Nurseries and garden supply stores                                      services                                   8557 Physical fitness facilities
2113 Farm labor and management services                   Other retail stores                                       7450 Carpet and upholstery cleaning             9597 Motion picture and video production
2212 Horticulture and landscaping           4614 Used merchandise and antique stores                                7476 Janitorial and related services (building, 9688 Motion picture and tape distribution and 
2238 Forestry, except logging                     (except motor vehicle parts)                                           house, and window cleaning)                     allied services
0836 Logging                                4630 Gift, novelty, and souvenir shops                                  Business and/or personal services               9613 Videotape rental
2246 Commercial lighting                    4655 Florists                                                           7617 Legal services (or lawyer)                 9639 Motion picture theaters
2469 Hunting and trapping                   4671 Jewelry stores                                                     7633 Income tax preparation                     9670 Bowling centers
Wholesale Trade - Selling Goods             4697 Sporting goods and bicycle shops                                   7658 Accounting and bookkeeping                 9696 Professional sports and racing, including
to Other Business, Etc.                     4812 Boat dealers                                                       7518 Engineering services                            promoters and managers
Durable goods, including machinery,         4838 Hobby, toy, and game shops                                         7682 Architectural services                     9811 Theatrical performers, musicians, agents,
     equipment, wood, metals, etc.          4853 Camera and photo supply stores                                     7708 Surveying services                              producers, and related services
2618 Selling for your own account           4879 Optical goods stores                                               7245 Management services                        9837 Other amusement and recreational services
2634 Agent or broker for other firms - more 4895 Luggage and leather goods stores                                   7260 Public relations
     than 50% of gross sales commission     5017 Book stores, including newsstands                                  7286 Consulting services
     Nondurable goods, including            5033 Stationary stores                                                  7716 Advertising, except direct mail            8888 Unable to classify
     food, fiber, chemicals, etc.           5058 Fabric and needlework stores                                       2675 Agent or broker for other firms - more 
2659 Selling for your own account           5074 Mobile home dealers                                                     than 50% of gross sales on commission
5884 Other retail stores                    5090 Fuel dealers (except gasoline)

                                        Instruction Sheet 2
   Instructions for Section D - Industry Description on the Business Application and Registration Form:
   For additional advice on Section D you may call the Labor Market Information office at (401) 462 - 8760.

D-1:  Please describe your RI worksite using the examples below as a guide.  Use separate lines for
each product or service and estimate the percentage of sales or work so we can count what you do most.

RETAIL TRADE: Describe the types of goods sold and the style of selling (for example: garden power tools 20% &
plant nursery 80%; gift, novelty & souvenir shop; discount department store, warehouse club, mail order catalog,
baked goods store, retail bakery, women's wear accessories, used car lot, vending machines,  on-line auction…).

WHOLESALE TRADE:    Specify if you have inventory at the RI establishment, the type of goods and whether they
are new or used.  Indicate if you are a "manufacturers' representative" commission sales agent without inventory.

FINANCE & INSURANCE:  be specific: e.g. securities market maker, venture capital, portfolio manager, mutual
fund sales, mortgage banker, mortgage broker, independent insurance agent, casualty underwriter, reinsurance….

CONSTRUCTION: Prime contractors: specify the usual type of structures (e.g. apartment, industrial, store, hotel or
office buildings; single-family houses, residential remodeling, bridges, roads, etc...) that you build.  Subcontractors
and tradesmen: tell us the trade or specialty and whether you work more at residential buildings or non-residential
structures (e.g. residential plumbing, industrial HVAC, non-residential finish carpentry, non-res. precast concrete…). 

MANUFACTURING: specify the products produced, type of facility, and principal processes used. List the principal
materials used and if bought from other companies, sent from other units of your business, or made at this site.

REAL ESTATE: be specific: (e.g.. realtor (agent), land developer (subdivider), apartment managers, lessor of offices).
If you rent out a building, what kind is it?  Do you own the property, sublet it or manage it for others?

RESTAURANTS specify: full (table) service restaurant, limited (counter) service restaurant, donut shop, snack bar, 
banquet hall, cafeteria, food service contract operator, caterer, dinner theater, bar, or nightclub.

TRANSPORTATION and/or WAREHOUSING:  Specify the transportation mode (e.g.  scheduled airline, courier
service, LTL trucking, specialized trucking...) and area of service (e.g. overnight long-haul, coastal, deep seas,...).
Related services: tell us what type (e.g. refrigerated warehouse, shipping agent, tour guides, sport-fishing charter...).

UTILITY or SANITATION SERVICE: specify separately each type of service (e.g. natural gas pipeline, 
gas distribution, hydroelectric generation, wholesale electricity reseller, water supply, recycleables sorting…)

COMMUNICATIONS: specify each type of service (e.g. local, long distance or data telephone service; radio 
network, cable TV service, leasing & reselling long distance telephone service, cell-phone carrier, etc…).

AGRICULTURAL, or FISHING... specify separately the types of crop grown, crop services, livestock raised, fish 
caught, horticultural specialty or forestry work.  Examples: 40% apples & 60% dairy goats, shellfish aquaculture….

PRIVATE HOUSEHOLD employing a cook, nanny or other domestic worker: you may write "domestic help."

SERVICES Describe the services that your establishment offers. (e.g. residential property management,  home health
equipment rental, C.P.A. accountants, tax return preparation, payroll office, marketing consultant,  environmental 
consultant, biotechnology r&d, portrait photography, veterinarian, employment placement agency, executive search,
temporary help, printing broker, psychiatry, dentistry, massage therapy, assisted living home, nursing home, motel,
bed & breakfast, transmission repair, auto body shop, nail salon, tanning salon, coin-operated dry cleaning…).

GOVERNMENT:  Indicate Federal, State, Tribal or Local.  Specify activities: legislative, judicial, school, etc….

Instruction Sheet 2 revised 30 July 2009

                                  State of Rhode Island 
                                  Division of Taxation 
                                  One Capitol Hill 
                                  Providence, RI 02908 
                                                  
           Taxpayer Status Affidavit / Identity Verification   

           All persons applying or renewing any license, registration, permit 
or other authority  (herein after called “licensee”) to conduct a business or 
occupation in the state of Rhode Island are required to file all applicable tax 
returns and pay all taxes owed to the state prior to receiving a license as 
mandated by state law (RIGL 5-76) except as noted below.   
 
In order to verify that the state is not owed taxes, licensees are required to 
provide their Social Security Number, or Federal Tax Identification Number as 
appropriate.  These numbers will be checked by the Division of Taxation to verify 
tax status prior to the issuance of a license.  This declaration must be made prior 
to the issuance of a license. 
 
                                  Licensee Declaration 
     I hereby declare, under penalty of perjury; 
 □ I have filed all required state tax returns and have paid all taxes owed.   

 □ I have entered a written installment agreement to pay delinquent taxes 
     that is satisfactory to the Tax Administrator.  
 □ I am currently pursuing administrative review of taxes owed to the state. 

 □ I am in federal bankruptcy. (Case # ___________________________) 

 □ I am in state receivership.  (Case # ___________________________) 

 □ I have been discharged from Bankruptcy. (Case # __________________) 
  
 Type of Permit(s)/License(s) for which you are applying  
  
 ___________________________       ____________________________ 
 Full Name (Please Print or Type)      Social Security Number (or FEIN if appropriate) 
  
 _____________________________________ ______________________________________
 Signature                             Phone Number (including area code if not 401) 
  
 __________________________________           
 Date 
  
 This completed Status Affidavit must be submitted with a Business Application Registration (Form 
     BAR) or any other License/Permit application filed with the Division of Taxation. 
     
2005 

No text to extract.

                                    STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS 
                                        DEPARTMENT OF REVENUE 
                                         DIVISION OF TAXATION 
                                        One Capitol Hill, Providence, RI   02908 
 
NAME: __________________________________________________________________ID#______________________________ 
 
MAILING ADDRESS: 
________________________________________________________________________________________ 
 
LOCATION ADDRESS: ______________________________________________________________________________________ 
(If different from mailing address) 
 
Please complete the following if you make sales of food and/or beverages: 
 
RIGL 44-18-18.1(2) states, "Eating and/or drinking establishments" mean and include restaurants, bars, taverns, lounges, 
cafeterias, lunch counters, drive-ins, roadside ice cream and refreshment stands, fish and chip places, fried chicken places, 
pizzerias, food and drink concessions, or similar facilities in amusement parks, bowling alleys, clubs, caterers, drive-in 
theatres, industrial plants, race tracks, shore resorts or other locations, lunch carts, mobile canteens and other similar 
vehicles, and other like places of business which furnish or provide facilities for immediate consumption of food at tables, 
chairs or counters or from trays, plates, cups or other tableware or in parking facilities provided primarily for the use of 
patrons in consuming products purchased at the location. Ordinarily, eating establishments do not mean and include food 
stores and supermarkets… 
 
     1.  a)    Based on the above definition, is your business an eating and/or drinking establishment? 
               ________yes ________no
 
        b)     This question is for food stores (convenience and mini-markets) and supermarkets only. Do you 
               provide chairs, tables, or counter in an area of your store where prepared food and/or beverages 
               may be consumed? 
               ________yes ________no 
                
        If you checked yes to either a or b, you are required to collect and report the local tax.  
        Please continue and respond to line 2 and 3. 
 
 2. Go to the back side of this page to complete the next question regarding business and delivery 
        location(s). 
  
 3. Please sign and return this questionnaire along with the Business Application and Registration form. 
 
        NOTE: If the return envelope is a window envelope, be sure to fold this sheet correctly to ensure that the 
        Division of Taxation address (on the back of this page) is properly displayed in the window portion of 
        the envelope. 
        
      ___________________________________                 ____________________________________ 
      Name of Contact Person                              Daytime Telephone Number 
       
     ___________________________________ 
     Signature 
 
     Any questions please contact the Excise Tax Department at (401)574-8955  

Rev. 03/2010 

ID:

Name:

LOCATION CITY/TOWN:

     Place a check mark next to the city or town where your eating and/or drinking establishment
is located.  Also, if applicable, check the other cities or towns in this state where you deliver meals
and/or beverages.

01 BARRINGTON                    21 NEWPORT
02 BRISTOL                       22 NEW SHOREHAM
03 BURRILLVILLE                  23 NORTH KINGSTOWN
04 CENTRAL FALLS                 24 NORTH PROVIDENCE
05 CHARLESTOWN                   25 NORTH SMITHFIELD
06 COVENTRY                      26 PAWTUCKET
07 CRANSTON                      27 PORTSMOUTH
08 CUMBERLAND                    28 PROVIDENCE
09 EAST GREENWICH                29 RICHMOND
10 EAST PROVIDENCE               30 SCITUATE
11 EXETER                        31 SMITHFIELD
12 FOSTER                        32 SOUTH KINGSTOWN
13 GLOCESTER                     33 TIVERTON
14 HOPKINTON                     34 WARREN
15 JAMESTOWN                     35 WARWICK
16 JOHNSTON                      36 WESTERLY
17 LINCOLN                       37 WEST GREENWICH
18 LITTLE COMPTON                38 WEST WARWICK
19 MIDDLETOWN                    39 WOONSOCKET
20 NARRAGANSETT

RHODE ISLAND DIVISION OF TAXATION
ONE CAPITOL HILL
PROVIDENCE, RI 02908