MAINE REVENUE…

                                                       MAINE REVENUE SERVICES
                                                       SOFT DRINK and SYRUP TAX
                                                             APPLICATION
1. BUSINESS INFORMATION:                                                           Email address
Legal Name                                                                         Business Trade Name
Social Security Number                                                             Business Phone Number
Federal Employer ID No. (EIN)                                                      Physical Location of Business
Primary Mailing Address



2. TYPE OF OWNERSHIP (check appropriate box):
    Sole Proprietor                 Partnership*                       Estate*                               Association*
    C Corporation (Regular)*        Limited Partnership*               Trust*                                Other*
    S Corporation (Sub "S")*.       Limited Liability Company*/**      Non Profit Organization (501(c)(3))*
    Corporation (Non Profit )*                                             (attach copy of IRS exemption letter)
* Federal Employer Identification Number (EIN) required above
** Form 8832 required, if filed with IRS - check one           corporation  sole proprietor  partnership
If you marked "Other", please explain type of ownership

Corporations -- Date Incorporated                                                   State of Incorporation

Limited Partnerships -- Date Registered                                             State of Registration

Limited Liability Co.'s -- Date Registered                                          State of Registration

3. REQUIRED OWNER INFORMATION (Names of directors, partners, officers or members; name of trustee or personal representative; name of
responsible party):
Name & Title                                                  Name & Title

Social Security Number (REQUIRED)                                         Social Security Number (REQUIRED)

% of Business Owned             Home Phone                                % of Business Owned           Home Phone

Home Address                                                              Home Address

4. TYPE OF BUSINESS
Check the type that applies to your business.
Distributor           Manufacturer        Wholesaler          Retailer 
5. SOFT DRINK & SYRUP TAX ACCOUNT ADDRESS FOR RETURNS AND NOTICES: Check if same as primary mailing address above: 

Address:                                                              Email:
                                                                      Attention:
                                                                      Telephone:


I certify that the information contained in each section of this application is true, correct and complete to the best of my knowledge and belief.
This application must be signed by an owner, director, partner, member, officer, trustee or personal representative, or responsible party.


           SIGNATURE                                          TITLE                          DATE                    TELEPHONE NUMBER



 Please print or type your name

                                                                     Mail to:
                                                            Maine Department of Labor
                                                            Central Registration Section
                                                                   PO Box 1057
                                                             Augusta, ME 04332-1057

                                      Central Registration - Fax # 207 287-3733 Phone # 207 621-5129
                                          MAINE REVENUE SERVICES
                                         SOFT DRINK and SYRUP TAX
                                         APPLICATION INSTRUCTIONS

Line 1 ­ BUSINESS INFORMATION

Legal Name - Enter the legal name of the entity, whether a sole proprietor, corporation, partnership, LLC etc. Social
Security Number - For sole proprietors only! Enter the Social Security Number for the person on the Legal Name line.
Federal Employer ID No. (EIN) ­ All other type of entities enter the EIN for the name on the Legal Name line. Primary
Mailing Address ­ Enter the address for the entity listed on the Legal Name line. Email address ­ Enter the email
address for the entity on the Legal Name line. Business Trade Name ­ Enter the business name, if different from the
Legal Name. Business Phone Number ­ Enter the phone number on this line. Physical Location of Business ­ Enter
the physical location of the business operation or the address of rental property.

Line 2 ­ TYPE OF OWNERSHIP               Check only one box for type of ownership.

Mark the ownership type that best applies. If you marked "Other", provide an explanation. Spouses must not check
"Partnership" unless the business files federal income tax returns (IRS form 1065) as a partnership. Corporations, limited
partnerships and limited liability companies must provide incorporation or registration information. For limited liability
companies, form 8832 is required, if filed with the IRS. Corporations must provide the Date Incorporated and the State of
Incorporation. Limited partnerships must provide the Date Registered and the State of Registration. Limited liability
companies must provide the Date Registered and the State of Registration.

Line 3 ­ REQUIRED OWNER INFORMATION                      Sole proprietors skip this line.

Corporations, partnerships, associations, nonprofit organizations and others must provide the names of two officers,
partners, members, or responsible parties. One must be the person responsible for the finances of the company or
organization. Social security numbers are required. A list of all partners or officers is not required.

Line 4 ­ TYPE OF BUSINESS                Check only one box for type of business.

Check only the box appropriate for your type of business.


Line 5 ­ SOFT DRINK & SYRUP TAX ACCOUNT ADDRESS                  Only if different than primary address.

If the returns and notices etc. will be mailed to the same address as Line 1, then check the box next to "Check if same as
primary mailing address above". If the returns and notices etc. need to be mailed to a different address, enter the
address. If there is an email address include that, as well as the phone number.

The application must be signed by a responsible party, such as a director, partner, member, officer,
trustee, personal representative, or some other responsible party.