BRT-801-A - State of West Virginia

STATE OF WEST VIRGINIA
State Tax Department, Revenue Division
P. O. Box 2666
Charleston, WV 25330-2666
Name
Address
City State Zip
Account #:
Location Info:
Name
Address
City State Zip
WV/BRT801A v 91-Web
REISSUANCE OF BUSINESS REGISTRATION CERTIFICATE (PERMANENT)
Taxpayers required to file electronically will no longer receive returns for the tax types subject to the mandatory requirement by mail.
Please visit www.wvtax.gov for additional information.
RETURN TO RECEIVE PERMANENT BUSINESS
REGISTRATION CERTIFICATE.
TAX ID:
1. If exempt from the registration fee, check ONE of the appropriate boxes:
Government Agency Agriculture or Farming Non-Profit Organization
Foreign Retailer voluntarily collecting &
remitting Use Tax on sales to W.Va. customers
2. If out of business, indicate last date business was conducted in W. Va.
3. Do you sell cigarettes or other tobacco products? Yes No
4. Primary NAICS Code
See Instructions on Back
$
5. Registration Fee Due: 30.00 Amount Remitted
.
MM
DD
YYYY
0 0
Business Name and/or Location Address Change:
Yes
No
If Yes, indicate new name and location address in the space
provided on the back of this return.
Mailing Address Change:
Yes
No
If Yes, indicate new mailing address in the space provided.
Street 1
City State Zip
(Signature of Taxpayer)
(Phone Number)
(Date)
MAIL TO: WEST VIRGINIA STATE TAX DEPARTMENT
Revenue Division
P. O. Box 2666, Charleston, WV 25330-2666
FOR ASSISTANCE CALL (304) 558-3333 TOLL FREE (800) 982-8297
For more information visit our web site at: www.wvtax.gov
File online at https://mytaxes.wvtax.gov
B 5 1 0 4 1 0 0 1 W

Your Business Registration Certificate will become permanent upon payment of a $30 fee and will be valid
until cessation of business or until revoked, suspended or cancelled by the Tax Commissioner. If you are
exempt from the $30 fee (line 1) you are still required to register. Operating a business without obtaining a
registration certificate and paying the applicable fee is a crime and may result in fines and/or imprisonment.
If you have changed your ownership or legal entity, you must return this form to cease your current business
and complete a new Business Registration Application (WV-BUSAPP) for your new business entity. The
application is available on our website at www.wvtax.gov or register online at www.Business4WV.com.
Tax Id - 9 digit Social Security Number (if your business is a sole proprietor with no employees) or Federal
Employer Identification Number (FEIN). This field may be left blank if you do not know or do not currently
have a FEIN. If you would like to obtain a FEIN, please visit www.IRS.gov.
Current Primary NAICS Code: Not Assigned
The NAICS (North American Industry Classification System) code printed above is your current business
activity. To ensure the State Tax Department has the most current information for your business, visit our
website at www.wvtax.gov for a list of NAICS codes (the list may be found by accessing Forms for Business
Registration) and enter the appropriate NAICS code in line four (4) of this form.
Briefly describe the type of business or activity you are conducting in West Virginia
New Business Name and/or New Location Address
Reason for Change: