PRINT FORM
AP-215 (Rev.8-07/3)
CONFIRMATION NUMBER
TEXAS ONLINE TAX REGISTRATION SIGNATURE FORM
Taxpayer name and mailing address
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 toll free at (800) 252-5555. The local number in Austin is (512) 463-4600. The TaxHelp E-mail address is: tax.help@cpa.state.tx.us.
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. 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's license number State
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Date
Date of Birth m m d
d
y
y
y
y
Type or print name and title of sole owner, partner, or officer
Driver's license number
State
/
Date
Date of Birth m m d
d
y
y
y
y
Type or print name and title of sole owner, partner, or officer
Driver's license number
State
/
Date
Date of Birth m m d
d
y
y
y
y
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 toll-free 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 toll free at 1-877-882-8890.