PRINT FORM AP-215 (Rev.6-09/5) CONFIRMATION NUMBER TEXAS ONLINE TAX REGISTRATION SIGNATURE FORM OPERATING WITHOUT A VALID PERMIT IS A MISDEMEANOR PUNISHABLE BY A FINE OF NOT MORE THAN $500 PER DAY. Texas taxpayer number WHO MUST SUBMIT THIS FORM - You must submit this form if you have registered for taxes online and received a confirmation number. FOR ASSISTANCE - If you have any questions about this application, contact your nearest Texas State Comptroller's office or call us at (800) 252-5555 or (512) 463-4600. The TaxHelp e-mail address is: [email protected] Sign up for e-mail updates on the Comptroller topics of your choice at www.window.state.tx.us. Click on "Sign up for our e-mail updates." WHO MUST SIGN THIS SIGNATURE FORM - The sole owner, all general partners, corporation or organization president, vice-president, secretary or treasurer, managing director or an authorized representative of an entity completing an online registration must sign this signature form attesting to the accuracy of the information submitted online. A representative must submit a written power of attorney (Form 01-137). Applicants must be 18 or older. Parents/Legal Guardians may apply for a permit on behalf of a minor. I (We) declare that the information submitted online and on 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 Driver license number State / Date Type or print name and title of sole owner, partner or officer Driver license number State / Date Type or print name and title of sole owner, partner or officer Driver license number State / Date 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.TexasOnline.com/portal/tol/en/9/1. You may also want to contact the municipality and county in which you will conduct business to determine any local governmental requirements. You have certain rights under Chapters 552 and 559, Government Code, to review, request and correct information we have on file about you. To request information for review or to request error correction, contact us at the address or phone number listed on this form. Complete and sign this form, and return it to your local Comptroller field office, or mail it to: TEXAS COMPTROLLER OF PUBLIC ACCOUNTS 111 E. 17th Street Austin, TX 78774-0100 Completed and signed signature forms may be faxed to (877) 882-8890.