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Get Navajo Nation ONTC 100 2014

FORM 100 DESIGNATION OF INDIVIDUAL Calendar Year 2014 EIN/SSN Any person owning an interest in a lease granted by the Navajo Nation or engaged in any business activity whatsoever within the Navajo Nation must register with the Office of the Navajo Tax Commission ONTC. Is your company related to any other company or person owning an interest in a lease granted by the Navajo Nation OR engaging in any business activity whatsoever within the Navajo Nation If yes please list company or person. I declare that the information contained in this document and any attachments thereto is true and correct to the best of my knowledge and belief pursuant to all Navajo Nation laws and regulations. x / Taxpayer or Duly Authorized Agent Signature ONTC Print or Type Name Form 100-2014 Date Revised 11/12/13. Please refer to instructions when completing this form* Please print legibly. Business Name Nature of Business 1. Designee s Information Name Title Mailing Address City State Zip Telephone Number Fax Number E-mail Address 2. Business Office if different from Section 1 Address 3. Navajo Nation Address if different from Sections 1 2 Telephone 4. This form applies to check one only 5. Type of Business check one only BAT SEV Corporation Partnership HOT TOB Joint Venture Sole Proprietorship FET SALES Other Specify 6. Month End of Accounting Year 7. Accounting Records kept on Cash Accrual basis. Physical Address of where records are located Street City and State 8. Is your company related to any other company or person owning an interest in a lease granted by the Navajo Nation OR engaging in any business activity whatsoever within the Navajo Nation If yes please list company or person* I declare that the information contained in this document and any attachments thereto is true and correct to the best of my knowledge and belief pursuant to all Navajo Nation laws and regulations. x / Taxpayer or Duly Authorized Agent Signature ONTC Print or Type Name Form 100-2014 Date Revised 11/12/13. Please refer to instructions when completing this form* Please print legibly. Business Name Nature of Business 1. Designee s Information Name Title Mailing Address City State Zip Telephone Number Fax Number E-mail Address 2. Designee s Information Name Title Mailing Address City State Zip Telephone Number Fax Number E-mail Address 2. Business Office if different from Section 1 Address 3. Navajo Nation Address if different from Sections 1 2 Telephone 4. Business Office if different from Section 1 Address 3. Navajo Nation Address if different from Sections 1 2 Telephone 4. This form applies to check one only 5. Type of Business check one only BAT SEV Corporation Partnership HOT TOB Joint Venture Sole Proprietorship FET SALES Other Specify 6. This form applies to check one only 5. Type of Business check one only BAT SEV Corporation Partnership HOT TOB Joint Venture Sole Proprietorship FET SALES Other Specify 6. Month End of Accounting Year 7. Accounting Records kept on Cash Accrual basis. Physical Address of where records are located Street City and State 8. .

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