FOR OFFICE USE ONLY State of Rhode Island Division of …

1 FOR OFFICE USE ONLYPERMIT #_____ BUSINESS APPLICATION and registration if YESANDI ncludeCompleteAdditionalYes NoFee:Sections:InformationDo you have employees working in RI?NoneA B C D EDo you have RI Withholding?NoneA B C EDo you lease employees in RI?NoneA B C D EDo you make sales at retail?$ A B E (A separate permit & fee is required for each location.)Sales Tax liability greater than $200 per unknown, check NO. Gasoline -$ Fee is for filling station or food -$ Fee is for litter permit. (Renewable on December 31st)Liquor -None License from city or town is required.$ Each cigarette vending machine requires a separate license and Vehicles -NoneIf yes, MV Dealer license # _____(required).Motor Vehicles leasing -NoneIf yes, MV Lease license # _____(required).Rental of room(s)/home(s) -None** Type of Rental: Residential Dwelling Rental Room RentalPrepaid wireless phone cards -NoneProduct?

2 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 NumberTYPE OF ENTITY: SOLE OWNER PARTNERSHIP CORPORATIONOTHER Please specify: _____ LLC- SOLE PROPRIETORName (Employer, Business, Corporation or Owner)RI Employment registration #(if assigned)Business Phone #Business name (if different from above)Federal Employer Ident. #(if assigned) State Zip-Code StateZip CodeIs any other license or permit required?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.

3 ( )NameStateZip CodeTelephone numberSection B: Type or Print Name, Social Security Number, Home Address, Title of Owner, each Partner, or each Corporate OfficerNameSocial Security # TitleTelephone Number Street AddressCity or TownStateZip Code NameSocial Security # TitleTelephone Number Street AddressCity or TownStateZip CodeForm BAR REVD 07/14/2015 LLC- CORPORATIONCity or Town State and Date of IncorporationSales Tax Permit #(if assigned)IF MORE THAN (1) LOCATION, PLEASE COMPLETE PART D-2 ON THE BACK OF THIS FORMS treet State of Rhode Island Division of Taxation One Capitol Hill STE 36 Providence, RI 02908-5829 City Cigarettes/Tobacco/Other Tobacco -LIMITED LIABILITY COMPANIES:Actual Rhode Island Location No. and Street (include apt. OFFICE or unit #, if any) CANNOT ACCEPT PO BOX # Mailing Address No and Street or BOX (include apt.)

4 OFFICE or unit#, if any) or TownWill you be selling: LLC-PARTNERSHIPFees and Instructions: Sales permit is renewable at fiscal year ending June 30thSection C: Payroll InformationAmount of RI withholding taxes you expect to withhold from employees each Status will beNumber of employees$24,000 or moreDaily$600 or more but less than $24,000 Quarter-Monthly First date wages paid in RI $50 or more but less than $600 MonthlyLess than $ 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 of Acquisition monthdayyearName of former ownerTrade NameStreet AddressCityStateZip CodeIf any employees were acquired from that business, please enter the number of employees you are a sole owner or partnership that is incorporating, State the name and address of the former business.

5 NameAddressSection D Industry Description%%%%%%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 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 (s) of Applicant(s)Print Name and TitleForm BAR REVD 07/14/2015RI Employment registration #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.

6 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 regardingStreetActivityEmployeesTown Zip Codethis 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 Tax and Litter Permits must be renewed CODES FOR Rhode Island CITIES AND TOWNSBARRINGTON01 CUMBERLAND08 JAMESTOWN15 NEW SHOREHAM22 RICHMOND29 WESTERLY36 BRISTOL02 EAST GREENWICH09 JOHNSTON16 NORTH KINGSTOWN23 SCITUATE30 WEST GREENWICH37 BURRILLVILLE03 EAST PROVIDENCE10 LINCOLN17 NORTH PROVIDENCE 24 SMITHFIELD31 WEST WARWICK38 CENTRAL FALLS 04 EXETER11 LITTLE COMPTON18 NORTH SMITHFIELD25 SOUTH KINGSTOWN32 WOONSOCKET39 CHARLESTOWN05 FOSTER12 MIDDLETOWN19 PAWTUCKET26 TIVERTON33 OUT OF STATE40 COVENTRY06 GLOCESTER13 NARRAGANSETT20 PORTSMOUTH27 WARREN34 CRANSTON07 HOPKINTON14 NEWPORT21 PROVIDENCE28 WARWICK35 BUSINESS CODES FOR PRINCIPAL BUSINESS ACTIVITYT hese authority titles and definitions are based, in general.

7 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 whichthe largest percentage of "total receipts" is derived. "Total receipts" means gross receipts plus all other Trade - Selling Goods to Individuals Finance, Insurance, Real Estate,7732 Employment agencies and personnel supplyConstructionand Householdsand Related Services7799 Consumer credit reporting and collection0018 Operative builders(for own account)3012 Selling door-to-door, by telephone or party plan,5520 Real estate agents or brokers servicesGENERAL CONTRACTORSor from mobile unit5579 Real estate property managers7856 Mailing, reproduction, commercial arts and0034 Residential building3038 Catalog or mail order5710 Subdividers and builders, except photography, and stenographic services0059 Nonresidential building3053 Vending machine sellingcemeteries7872 Computer programming, processing, data0075 Highway and street constructionSelling from Showroom, Store, or other 5538 Operators and lessors of buildings,preparation, and related services3889 Other heavy construction (pipe laying,Fixed Locationincluding residential7922 Computer repair, maintenance, and leasingbridge construction, etc.)

8 Building Food, beverages, and drugs5553 Operators and lessors or other7773 Equipment rental and leasing trade contractors, including repairs3079 Eating places (meals or snacks)real property(except computer or automotive)0232 Plumbing, heating, air conditioning3086 Catering services5702 Insurance agents or brokers7914 Investigative and protective services0257 Painting and paper hanging3095 Drinking places (alcoholic beverages)5744 Other insurance services7880 Other business services0273 Electrical work3210 Grocery stores (general line)6064 Security brokers and dealers0299 Masonry, dry wall, stone, tile0612 Bakeries selling at retail6080 Commodity contracts brokers and8110 Beauty shops (or beautician)0414 Carpentering and flooring3236 Other food stores (meat, produce, candy, etc.)dealers, and security and commodity8318 Barber shop (or barber)0430 Roofing, siding, and sheet metal3251 Liquor storesexchanges8334 Photographic portrait studios0455 Concrete work3277 Drug stores6130 Investment advisors and services8532 Funeral services and crematories0885 Other building trade contractors6148 Credit institutions and mortgage bankers8714 Child day care(excavation, glazing, etc.)

9 3319 New car dealers (franchised)6155 Title abstract offices8730 Teaching or tutoringManufacturing, including3335 Used car dealers5777 Other finance and real estate8755 Counseling (except health practitioners)Printing and publishing3517 Other automotive dealers (motorcycles,Transportation, Communications,8771 Ministers and chaplains0638 Food products and beveragesrecreational vehicles, etc.)Public Utilities, and Related Services6882 Other personal services0653 Textile mill products3533 Tires, accessories, and parts6114 TaxicabsAutomotive services0679 Apparel and other textile products3558 Gasoline service stations6321 Bus and limousine transportation8813 Automotive rental or leasing, without driver0695 Leather, footwear, handbags, highway passenger transportation8839 Parking, except valet0810 Furniture and fixtures3715 Variety stores6338 Trucking (except trash collection)8953 Automotive repairs, general and specialized0836 Lumber and other wood products3731 Other general merchandise stores6395 Courier or package delivery services8896 Other automotive services (wash, towing, etc.)

10 0851 Printing and publishing3756 Shoe stores6510 Trash collection without own dump0877 Paper and allied products3772 Men's and boys' clothing stores6536 Public warehousing9019TV and audio equipment repair1032 Stone, clay, and glass products3913 Women's ready-to-wear stores6551 Water transportation9035 Other electrical equipment repair1057 Primary metal industries3921 Women's accessory and specialty stores 6619 Air transportation9050 Reupholstery and furniture repair1073 Fabricated metal productsand furriers6635 Travel agents and tour operators2881 Other equipment repair1099 Machinery and machine shops3939 Family clothing stores6650 Other transportation services1115 Electric and electronic equipment3954 Other apparel and accessory stores6676 Communication services9217 Offices and clinics of medical doctors (MOs)1883 Other manufacturing industries3970 Furniture stores6692 Utilities including dumps, snowplowing,9233 Offices and clinics of dentistsMining and Mineral Extraction3996TV, audio, and electronicsroad clearing, physicians and surgeons1511 Metal mining3988 Computer and software storesServices (Personal, Professional,9241 Podiatrists1537 Coal mining4119 Household appliance storesand Business Services9274 Chiropractors1552 Oil and gas4317 Other home furnishing stores (china, floor 9290 Optometrists1719 Quarrying and nonmetallic miningcoverings, etc.))