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STATE OF RHODE ISLAND DIVISION OF TAXATION ONE CAPITOL HILL PROVIDENCE RI 02908 RETAIL SALES PERMIT RENEWAL APPLICATION DUE ON OR BEFORE JANUARY 31 2009 Please forward renewal fee of 10. 00 as soon as possible to be guaranteed a new permit when you receive your July sales tax booklet. Annual sales tax renewal fee 10. 00 For Fiscal year BEGINNING JULY 1 2009 ENDING JUNE 30 2010 PERMIT NUMBER Permit Number REQUIRED NAME AND ADDRESS Name Address Number and street including apartment number or rural route City Town or Post Office State Zip Code Daytime Telephone Number Check here if this is a new address. SIGNATURE Authorized Signature Date INSTRUCTIONS Do NOT mail with tax return* Submit a separate form for each individual permit held. 00 as soon as possible to be guaranteed a new permit when you receive your July sales tax booklet. Annual sales tax renewal fee 10. 00 For Fiscal year BEGINNING JULY 1 2009 ENDING JUNE 30 2010 PERMIT NUMBER Permit Number REQUIRED NAME AND ADDRESS Name Address Number and street including apartment number or rural route City Town or Post Office State Zip Code Daytime Telephone Number Check here if this is a new address. 00 For Fiscal year BEGINNING JULY 1 2009 ENDING JUNE 30 2010 PERMIT NUMBER Permit Number REQUIRED NAME AND ADDRESS Name Address Number and street including apartment number or rural route City Town or Post Office State Zip Code Daytime Telephone Number Check here if this is a new address. SIGNATURE Authorized Signature Date INSTRUCTIONS Do NOT mail with tax return* Submit a separate form for each individual permit held. 00 as soon as possible to be guaranteed a new permit when you receive your July sales tax booklet. Annual sales tax renewal fee 10. 00 For Fiscal year BEGINNING JULY 1 2009 ENDING JUNE 30 2010 PERMIT NUMBER Permit Number REQUIRED NAME AND ADDRESS Name Address Number and street including apartment number or rural route City Town or Post Office State Zip Code Daytime Telephone Number Check here if this is a new address. SIGNATURE Authorized Signature Date INSTRUCTIONS Do NOT mail with tax return* Submit a separate form for each individual permit held.

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