Texas Original Application for Coin-Operated Machine

General Business License, Import License and/or

Repair License and Tax Permit(s)
GLENN HEGAR TEXAS COMPTROLLER OF PUBLIC ACCOUNTS
General Instructions –
• Do not write in shaded areas.
• Do not separate pages.
• Enter physical address when requested. Do NOT enter P.O. Box or rural route.
• The license fee and the occupation tax due for your machine tax permits must be sent with this application. Payment must be made payable to the
State Comptroller.
• Do NOT send cash.

Specific Instructions –
• You MUST complete the Texas Coin-Operated Machine Ownership Statement (Form AP-138), to identify owners, partners, officers, members,
managers, directors and/or corporate stockholders. A written request must be sent to change (add or delete) owner information. Omit all corporate
stockholders owning less than 10% of the business.
• Each machine must be registered with the Comptroller by:
a. serial number/inventory I.D. number;
b. make or manufacturer and;
c. type (pinball and darts are type D "other").
• A computer printout of your machine inventory, the Coin-Operated Machine Inventory Supplement For General Business License Holders, (Form
AP-145), may be used instead of completing the inventory list on Page 3. The printout must be numbered and contain all inventory owned at the
time your application is submitted.
• If you purchase additional machines during the year, you must complete the Texas Application for Additional Coin-Operated Machine Tax Permits
(Form AP-141).
• Current calendar year tax permits can be transferred with the sale of a machine by filing a Coin-Operated Machine Tax Permit(s) Ownership Transfer
Statement, (Form AP-212).
• Each coin-operated machine must have a serial number, owner's name and telephone number that is clearly visible on the outside of the machine.
If a machine is manufactured without a serial number, the machine owner must assign a serial number and stamp or engrave the number on the
machine.
• An occupation tax permit issued by the Comptroller MUST be affixed to each registered machine when it is placed on location. Permits MUST be
securely affixed to each registered machine on location and in a manner that can be clearly seen by the public and cannot be placed on top of
another permit.
• Licenses and permits expire December 31 of each year.
• Renewals are due November 30 of each year. If the due date falls on a Saturday, Sunday or legal holiday, the next business day will be the due
date.
• This application must have the signatures of the recordkeeper and the applicant.
• If you purchase a machine from an out-of-state vendor without paying Texas tax, use tax must be reported. If you paid Texas use tax to a vendor,
you are not required to report the tax. That vendor must provide you with a receipt showing, among other things, the amount of use tax collected.
You should retain a copy of the receipt showing you paid Texas use tax.
• A Texas Sales and Use Tax Permit is required to sell coin-operated machines.
The General Business, Import and Repair Licenses are three separate and distinct licenses.
This application, for one or a combination of these licenses, MUST be submitted by any person (sole owner, partnership, corporation or other group) that
intends to engage in any business dealing with coin-operated amusement machines.
• A license cannot be issued to anyone who has been convicted of a felony during the past five years or has been on probation or parole as a result
of a felony conviction in the past two years.
• A license cannot be issued to anyone indebted to the State of Texas for any fees, costs or penalties or to anyone currently delinquent in the pay-
ment of any tax collected by the Comptroller.
• A license may not be issued if applicant fails to designate and maintain an office in this state for the purpose of maintaining records as required by
the Coin-Operated Machines Law.
• Applicant must designate an individual responsible for keeping records and reporting to the Comptroller all information required by the Coin-Operated
Machines Law. The designated individual must have a relationship to the business to be licensed as required by the Coin-Operated Machines Law
and sign a statement accepting the responsibility of maintaining records and reporting information as required by the Coin-Operated Machines
Law.
Completed application and payment should be mailed to Comptroller of Public Accounts
111 E. 17th St.
Austin, TX 78774-0100

For Assistance – If you have any question about this application, call us at 1-800-531-5441 ext. 33731.
Federal Privacy Act – Disclosure of your social security number is required and authorized under law, for the purpose of tax administration and
identification of any individual affected by applicable law. 42 U.S.C. §405(c)(2)(C)(i); Tex. Govt. Code §§403.011 and 403.078. Release of information
on this form in response to a public information request will be governed by the Public Information Act, Chapter 552, Government Code, and applicable
federal law.
Americans with Disabilities Act – In compliance with the Americans with Disabilities Act, this document may be requested in alternative formats by
calling 1-800-252-5555.

Under Ch. 559, Government Code, you are entitled to review, request and correct information we have on file about you, with limited exceptions in accordance
with Ch. 552, Government Code. To request information for review or to request error correction, contact us at the address or phone numbers listed on this form.
AP-147-1 (Rev.7-18/18)
 AP-147-2 Texas Original Application for
(Rev.7-18/18)
Coin-Operated Machine PRINT FORM RESET FORM
General Business License, Import License and/or
Repair License and Tax Permit(s)
• Please read instructions. • Type or print. • Do NOT write in shaded areas. Page 1
LICENSE TYPE

The application for calendar year

1. Texas Comptroller's taxpayer number.......................................................................................

2. Check the type(s) of license(s) applied for: 1 - General 2 - Import 3 - Repair

3. Legal name of owner (sole owner, partnership, corporation or other name)

4. Mailing address (street number and name, P.O. Box or rural route and box number)

City State ZIP code County

Business email address

5. Enter the daytime phone number of the person primarily responsible for filing tax returns. ....................... - -
TAXPAYER INFORMATION

6. Enter your Social Security number if you are a sole owner. ................................................................................... - -

7. Enter your Federal Employer Identification Number (FEIN), if any. ................................................................................ -

3

8. If you are incorporating an existing business, enter the taxpayer number of the existing business. .....................

9. Enter your taxpayer number for reporting any Texas tax OR your Texas
Vendor Identification Number if you now have or have ever had one. .......................................................................

10. Indicate how your business is owned. 1 - Sole owner 2 - Partnership 3 - Texas corporation
7 - Limited partnership Foreign corporation Other (explain) ________________________________________________________

Charter, file or COA date

State Texas Secretary of State file number or COA no. month day year

11. If this business is a corporation, enter......................................

Home state Identification number

12. If your business is a limited partnership, enter the home state and identification number. ..........

All applicants MUST complete the Texas Coin-Operated Machine Ownership Statement (Form AP-138).
RECORDS MAINTAINED

13. Office address in Texas where records will be maintained:

(Use street and number or directions; use 9-1-1 address, if possible. The P.O. Box or rural route number are NOT acceptable.)

City State ZIP code County

The individual responsible for keeping records must be an owner, partner, officer, trustee, receiver or principal member of the business and must
be listed in the Texas Coin-Operated Machine Ownership Statement, (Form AP-138). Occupations Code Sec. 2153.153(c).
 AP-147-3 Texas Original Application for
(Rev.7-18/18)
Coin-Operated Machine
General Business License, Import License and/or
Repair License and Tax Permit(s)
• Please read instructions. • Type or print. • Do NOT write in shaded areas. Page 2
Legal name (same as Item 3)

14. Check the applicable boxes and complete the information below:
Position (Check all applicable boxes.) Percentage of ownership or
corporate
Sole owner Partner Director Officer Corporate stockholder Record keeper stock held %
Name (first, middle initial, last) Social Security number Driver license number and state

Home address (street number and name) City State ZIP code

Daytime phone (area code and number) Date of birth (mmddyyyy)

- -
Position (Check all applicable boxes.) Percentage of ownership or
corporate
Partner Director Officer Corporate stockholder Record keeper stock held %
Name (first, middle initial, last) Social Security number Driver license number and state

Home address (street number and name) City State ZIP code

Daytime phone (area code and number) Date of birth (mmddyyyy)

- -
Position (Check all applicable boxes.) Percentage of ownership or
corporate
Partner Director Officer Corporate stockholder Record keeper stock held %
Name (first, middle initial, last) Social Security number Driver license number and state

Home address (street number and name) City State ZIP code
APPLICANT INFORMATION

Daytime phone (area code and number) Date of birth (mmddyyyy)

- -
Position (Check all applicable boxes.) Percentage of ownership or
corporate
Partner Director Officer Corporate stockholder Record keeper stock held %
Name (first, middle initial, last) Social Security number Driver license number and state

Home address (street number and name) City State ZIP code

Daytime phone (area code and number) Date of birth (mmddyyyy)

- -
Position (Check all applicable boxes.) Percentage of ownership or
corporate
Partner Director Officer Corporate stockholder Record keeper stock held %
Name (first, middle initial, last) Social Security number Driver license number and state

Home address (street number and name) City State ZIP code

Daytime phone (area code and number) Date of birth (mmddyyyy)

- -
Position (Check all applicable boxes.) Percentage of ownership or
corporate
Partner Director Officer Corporate stockholder Record keeper stock held %
Name (first, middle initial, last) Social Security number Driver license number and state

Home address (street number and name) City State ZIP code

Daytime phone (area code and number) Date of birth (mmddyyyy)

- -
––– Attach additional sheets, if necessary. –––
 AP-147-4 Texas Original Application for
(Rev.7-18/18)
Coin-Operated Machine
General Business License, Import License and/or
Repair License and Tax Permit(s)
• Please read instructions. • Type or print. • Do NOT write in shaded areas. Page 3
Legal name (same as Item 3)
BUSINESS LOCATION

15. Trade name of business/ machine location Business phone (area code and number)
- -
16. Location of business
(If business location address is a rural route and box number, provide directions or use 9-1-1 address, if possible.)

City State ZIP code County

17. For each machine OWNED, list the serial number/inventory I.D. number, make, machine type and indicate whether each machine is exhibited or displayed on location.

MACHINE SERIAL MACHINE MAKE EXHIBITED OR

MACHINE TYPE CODE DISPLAYED ON
NUMBER/INVENTORY OR (Use letter codes from Item 18)
I.D. NUMBER MANUFACTURER LOCATION

1. YES NO

2. YES NO

3. YES NO

4. YES NO

5. YES NO

6. YES NO

7. YES NO
MACHINE INFORMATION

8. YES NO

9. YES NO

10. YES NO

11. YES NO

12. YES NO

13. YES NO

14. YES NO

15. YES NO

16. YES NO

17. YES NO

18. YES NO

19. YES NO

20. YES NO

For additional inventory, complete the Coin-Operated Machine Inventory Supplement for General Business License Holders (Form AP-145),
or a computer printout of all numbered inventory may be used. If you use a computer printout, you MUST complete Items 18-20.

18. Enter the number of each type of music, skill or pleasure coin-operated machine that is exhibited or displayed in this location.

–A– –B– –C– –D–

MUSIC POOL TABLES VIDEO GAMES OTHER

19. Total number of machine in this location that require tax permits(Total of items 18A-D)....................................................................
 AP-147-5 Texas Original Application for
(Rev.7-18/18)
Coin-Operated Machine
General Business License, Import License and/or
Repair License and Tax Permit(s)
• Please read instructions. • Type or print. • Do NOT write in shaded areas. Page 4
Legal name (same as Item 3)

20. TOTAL NUMBER of machines in ALL locations that require tax permits.
(Total of item 19 from this location and item 6 from all Supplemental Forms AP-145) .................................................. ____________________

21. Enter the total number of machines that you OWN ...................................................................................................... ____________________
License Fee(s) – To determine the license fee due, use the number of machines that you OWN shown in Item 21 and select the correct fee from the schedule
below. NOTE: If you now hold or are applying for a General Business License and/or and Import License, the right to repair machines is included, and no
Repair License or fee is required.
General Business License Fee Schedule
LICENSE FEE

These fees cannot be prorated.

Applicant with 50 or fewer machines ...............................................................$200.00
Applicant with 51 to 200 machines ..................................................................$400.00
Applicant with over 200 machines ...................................................................$500.00
Import license...................................................................................................$500.00
Repair license ....................................................................................................$50.00
22. Amount due for General Business License................................................................................................................. $ ____________________

23. Amount due for Import License ................................................................................................................................... $ ____________________

24. Amount due for Repair License .................................................................................................................................. $ ____________________

25. TOTAL LICENSE FEE(S) DUE (Total of items 22 - 24) ............................................................................................. $ ____________________
AMT. DUE OCCUPATION TAX PERMIT CALC.

When you calculate the occupation tax due on your coin-operated machines, DO NOT include coin-operated cigarette, service, merchandise vend-
ing machines, coin-operated amusement machines designed exclusively for children or machines PERMANENTLY taken out of service.

26. Calculate the occupation tax due for all machines placed on location during this application year. Multiply the total number of machines placed
on location for the first time in the appropriate calendar quarter by the rate for that quarter.

a. 1st quarter (January - March): ....... ________________ machines at $60.00 each = $ __________________
b. 2nd quarter (April - June): ............. ________________ machines at $45.00 each = $ __________________
c. 3rd quarter (July - September): ..... ________________ machines at $30.00 each = $ __________________
d. 4th quarter (October - December): ________________ machines at $15.00 each = $ __________________

27. TOTAL OCCUPATION TAX DUE (Total Items 26a-d) ..................................................................................................$ ____________________

28. TOTAL AMOUNT DUE (Item 25 plus Item 27) .............................................................................................................$ ____________________
Total amount due must be paid with this application.

Date of signature
29. The sole owner, all general partners, corporation or organization president, vice-president, month day year
secretary or treasurer, managing director or an authorized representative and the recordkeeper
must sign. A representative must submit a written power of attorney.
The law provides that a person who knowingly secures or attempts to secure a license by fraud, misrepresentation or subterfuge is guilty of a
second degree felony and upon conviction is punishable by confinement for two (2) to twenty (20) years and a fine up to $10,000.
(Occupations Code Sec. 2153.357; Penal Code Sec. 12.33)
I (We) declare that the information in this document and 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 license number / state Sole owner, partner or officer
STATEMENT

Type or print name and title of partner or officer Driver license number / state Partner or officer

Type or print name and title of partner or officer Driver license number / state Partner or officer

By signing below as the designated recordkeeper, I agree to accept responsibility for the maintenance of records and reporting of information to the
Comptroller as required by Occupations Code Sec. 2153.153 and 2153.202.
Type or print name of recordkeeper Driver license number / state Recordkeeper

WARNING. You may be required to obtain an additional permit or license from the State of Texas or from a local governmental entity to
conduct business. A listing of links relating to acquiring licenses, permits, and registrations from the State of Texas is available online at
http://www.Texas.gov. You may also want to contact the municipality and county in which you will conduct business to determine
any local governmental requirements.