B-202A Web 11-09 Application for State Privilege License North Carolina Department of Revenue For the year beginning July 1, For Office Use Only and ending June 30, First-Time Applicant If first-time applicant, enter start date of activity that requires this license. Renewal Applicant If renewal applicant, enter account number for this license. Part 1. Professional Individuals First Name M.I. Last Name Social Security Number Daytime Phone (Include area code) Name of Business Where Professional Individual Is Employed (optional) Address Where License Is To Be Mailed (This address is printed on the license.) City State Zip Code (5 Digits) County Enter Code Number and License Description from Table on Reverse Part 2. Loan Agencies, Check Cashers, or Pawnbrokers Loan Agency Check Casher Pawnbroker Legal Name of Business Federal Employer ID Number Business Phone (Include area code) Street Address of Business City State Zip Code (5 Digits) County Address Where License Is To Be Mailed (If different from street address) City State Zip Code (5 Digits) Part 3. Computation of Privilege License Tax 1. Total Privilege License Tax Due (From Table on Reverse) 2. Penalty 3. Interest $ , 4. Total Payment Due (Add Lines 1 through 3) Signature: I certify that, to the best of my knowledge, this application is accurate and complete. . . . . Date: Attach your check or money order to this application. Payment must be in the form of U.S. currency from a domestic bank. North Carolina Department of Revenue, P.O. Box 25000, Raleigh, NC 27640-0100 American LegalNet, Inc. www.FormsWorkFlow.com Page 2 B-202A Web 11-09 Instructions General Information: Use this form if you are beginning in business and do not have the required State privilege license. If you are renewing your State privilege license, it is preferable to use the renewal notice you received from the Department of Revenue instead of this form. Use a separate form for each profession and each business location. Professional individuals complete Part 1. Loan agencies, check cashers, or pawnbrokers complete Part 2. Fill in the applicable circle for Parts 1 and 2 to indicate whether this application is a first time applicant or a renewal applicant. Complete the form in blue or black ink. Do not send a photocopy of this form. The original form is printed in pink and black ink. Individuals who engage in the practice of a profession listed in the following table and loan agencies, check cashers, and pawnbrokers must obtain a State privilege license and pay a tax before they engage in business. For purposes of this tax, an individual engages in the practice of a profession when the person represents to the public that the person is engaged in the profession. The tax does not apply to an individual who is a salaried employee of a governmental unit unless either the unit charges a fee for the services of the employed individual and the individual receives part or all of the fee, either directly or indirectly, or the individual engages in practice outside the salaried employment. Code Number License Description Tax 427 429 430 431 432 433 434 435 436 437 438 439 440 441 Code Number Accountant $50.00 442 Certified Public Accountant $50.00 443 Assistant Accountants (Per 444 assistant issued in the name 445 of the manager) _____(Number 446 of Assistants) X $12.50 $ 447 Architect $50.00 448 Art of Healing $50.00 449 Attorney $50.00 450 Chiropodist $50.00 451 Chiropractor $50.00 Dentist $50.00 Embalmer $50.00 452 Engineer $50.00 453 Land Surveyor $50.00 567 Landscape Architect $50.00 568 Naturopath $50.00 569 License Description Tax Ophthalmologist $50.00 Optician $50.00 Optometrist $50.00 Osteopath $50.00 Photographer $50.00 Photographer’s Agent $50.00 Physician $50.00 Podiatrist $50.00 Psychologist $50.00 Real Estate (Only one license required if engaged in multiple real estate activities) $50.00 Veterinarian $50.00 Licensed Home Inspector $50.00 Loan Agency $250.00 Check Casher $250.00 Pawnbroker $250.00 Tax Year: The State privilege license tax is an annual tax that is imposed on a fiscal year basis that begins July 1 and ends the following June 30. Enter the appropriate year in the space provided. A first-time applicant must enter the date the applicant will start to engage in the activity that is subject to tax. The tax must be paid before the applicant engages in the activity. An applicant who starts to engage in an activity after July 1 of a year may not prorate the tax. Name and Tax Identification Number: If you are a professional individual other than an assistant accountant, enter your name and social security number. Assistant accountants should enter the name and social security number of their principal or manager. A license issued to an individual who engages in a profession is issued as a personal privilege license and is not issued in the name of a firm or another business entity. If you are a loan agency, check casher, or pawnbroker, enter the legal name of the business, any trade name of the business, and the federal employer identification number of the business. A license issued to a loan agency, check casher, or pawnbroker is issued in the business name. Due Date: An initial annual State privilege license tax is due before the start of the activity that requires the license. An application for an initial privilege license made after the start date of the activity is subject to penalties for failure to obtain a license (5% per month, with 25% maximum and $5 minimum) and failure to pay a tax when due (10% of tax due, $5 minimum). A renewal of an annual State privilege license tax is due by July 1. A late renewal application is subject to penalties for failure to obtain a license (5% per month, with 25% maximum and $5 minimum) and failure to pay a tax when due (10% of tax due, $5 minimum). Interest will be due on the unpaid tax. The rate is set semiannually by the Secretary of Revenue and is available on the Department’s website, www.dornc.com. Questions: If you have questions about this form, call toll free 1-877-308-9103. 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