Texas Application for Motor Vehicle
Seller-Financed Sales Tax Permit
General Information
Who Must Submit This Application -
You must submit this application if you are a sole owner, partnership, corporation or other organization which intends to finance sales of motor vehicles
Applicants must hold a motor vehicle license issued by the Texas Department of Motor Vehicles.
Applicants should contact the Office of Consumer Credit Commissioner concerning a Motor Vehicle Dealer's Financing license.
For Assistance -
If you have questions about this application or any other tax-related matter, please contact your nearest Texas State Comptroller's office, or call (800) 252-1382 or (512) 463-4600. Our email address is tax.help@cpa.state.tx.us, or see our website at www.window.state.tx.us. Representa- tives are available to help you with questions, by phone, Monday through Friday (except Federal holidays), from 7:30 a.m. to 5:30 p.m.
General Instructions -
•Please do not separate pages.
•Write only in white areas.
•Completed and signed application should be mailed to:
Comptroller of Public Accounts
111 E. 17th St.
Austin, TX 78774-0100
Federal Privacy Act -
Disclosure of your Social Security number is required and authorized under law, for the purpose of tax administration and identification of any individual affected by applicable law. 42 U.S.C. §405(c)(2)(C)(i); Tex. Govt. Code §§403.011 and 403.078. Release of information on this form in response to a public information request will be governed by the Public Information Act, Chapter 552, Government Code, and applicable federal law.
You have certain rights under Chapters 552 and 559, Government Code, to review, request and correct information we have on file about you. Contact us at the address or phone numbers listed on this form.
AP-169-1 (Rev.8-11/10)
Texas Application for Motor Vehicle Seller-Financed Sales Tax Permit
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Please read instructions. |
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• Type or print. |
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• Do NOT write in shaded areas. |
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Page 1 |
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SOLE OWNER IDENTIFICATION |
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1. |
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Name of sole owner (first name, middle initial and last name) |
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2. |
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Social Security number (SSN) |
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3. Taxpayer number for reporting any Texas tax OR Texas Identification |
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Check here if you DO NOT |
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Number if you now have or |
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have a SSN. |
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have ever had one. |
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5.Legal name of partnership, company, corporation, association, trust or other
6.Taxpayer number for reporting any Texas tax OR Texas Identification Number if you now have or have ever had one.
7. Federal Employer Identification Number (FEIN) assigned by the Internal Revenue Service ................................
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...............................................................................................................Check here if you do not have an FEIN. |
BUSINESS INFORMATION
TAXPAYER INFORMATION
9. |
Mailing address |
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Street number, P.O. Box or rural route and box number |
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State/province |
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County (or country, if outside the U.S.) |
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10. |
Name of person to contact regarding day to day business operations |
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Daytime phone |
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( |
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If you are a SOLE OWNER, skip to Item 16.
11. If the business is a Texas profit corporation, nonprofit corporation, professional corporation |
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month day |
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or limited liability company, enter the file number issued by the Texas Secretary of State |
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and date |
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12.If the business is a non-Texas profit corporation, nonprofit corporation, professional corporation or limited liability company, enter the state or country of incorporation, charter number and date, Texas Certificate of Authority number and date.
State/country of inc.Charter numbermonth day year Texas Certificate of Authority number month day year
13. If the business is a corporate entity, have you been involved in a merger within the last seven years? |
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YES |
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NO |
If "YES," attach a |
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detailed explanation. |
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14. If the business is a limited partnership or registered limited liability |
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State |
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Number |
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partnership, enter the home state and registered identification number |
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15. Enter information for all partners - Attach additional sheets, if necessary. |
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*If a general partner is an individual, enter the SSN of the individual. |
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Name |
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Title |
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Phone (area code and number) |
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Home address |
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*SSN or FEIN |
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Date of birth |
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Driver license number |
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County (or country, if outside the U.S.) |
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month |
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Percent of |
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ownership |
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Position held: |
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Partner |
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Officer |
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Director |
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Corporate stockholder |
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Record keeper |
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Name |
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Title |
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Phone (area code and number) |
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Home address |
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*SSN or FEIN |
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Date of birth |
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Driver license number |
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State |
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month |
day |
year |
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Percent of |
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ownership |
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Position held: |
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Partner |
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Officer |
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Director |
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Corporate stockholder |
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Record keeper |
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Texas Application for Motor Vehicle Seller-Financed Sales Tax Permit
• Please read instructions. |
• Type or print. |
• Do NOT write in shaded areas. |
Page 2 |
16. Legal name of owner (same as Item 1)
PREVIOUS OWNER INFORMATION
BUSINESS LOCATION AND INFORMATION
SIGNATURES
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--- If you purchased an existing business or business assets, complete Items 17-20. If you did not, skip to Item 21. --- |
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17. |
Enter the former owner's name. If known, enter the former owner's Texas taxpayer number. |
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Trade name |
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Taxpayer number of former owner |
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18. |
Enter the former owner's legal name. If known, enter the former owner's address and telephone number. |
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Legal name of former owner |
Phone (area code and number) |
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Address of former owner (street and number, city, state, ZIP code)
19. Check each of the following items you purchased.

Inventory 
Corporate stock 
Equipment 
Real estate 
Other assets 20. Enter the purchase price of the business or assets purchased and the date of purchase.
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Purchase price |
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Date of purchase |
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21. Enter the trade name, location and dealer number for all your places of business. (Attach additional sheets, if necessary.)
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Trade name of your business |
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Business phone (area code and number) |
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Location of your business (Use street and number or directions - NOT P.O. Box or rural route number.) |
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Dealer number |
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City |
State |
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ZIP code |
County |
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Trade name of your business |
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Business phone (area code and number) |
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Location of your business (Use street and number or directions - NOT P.O. Box or rural route number.) |
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Dealer number |
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City |
State |
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ZIP code |
County |
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Trade name of your business |
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Business phone (area code and number) |
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Location of your business (Use street and number or directions - NOT P.O. Box or rural route number.) |
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Dealer number |
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City |
State |
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ZIP code |
County |
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22. Do you sell diesel-powered, on-road motor vehicles with a gross vehicle registered weight exceeding 14,000 pounds? |
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YES |
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NO |
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23. Enter the dealer number for your primary location as assigned by the Texas Department of Motor Vehicles |
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24.Enter the date of the first business operation in Texas subject to the Seller-Financed Motor Vehicle Receipts Tax (The date cannot be prior to Oct. 1, 1993.) .....................................................................................................................
The sole owner, all general partners, corporation president, vice-president, secretary or treasurer or an |
Date of application |
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authorized representative must sign this application. Representative must submit a power of attorney with |
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the application. (Attach additional sheets if necessary.) |
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25. I (We) declare that the information in this document and any attachments is true and correct to the best of my (our) knowledge and belief.
Type or print name and title of sole owner, partner or officer |
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Sole owner, partner or officer |
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Type or print name and title of partner or officer |
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Partner or officer |
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Type or print name and title of partner or officer |
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Partner or officer |
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WARNING. You may be required to obtain an additional permit or license from the State of Texas or from a local governmental entity to conduct business. A listing of links relating to acquiring licenses, permits, and registrations from the State of Texas is available online at http://www.Texas.gov. You may also want to contact the municipality and county in which you will conduct business to determine any local governmental requirements.