FEIN ______________________________________________
3. Mailing Address if dierent from the Mailing Address in Section I.
Street Address or P.O. Box City, State, ZIP Code
4. Contact Information. If dierent from Primary Contact in Section I, enter contact information for this tax.
Name Title Contact Phone Number
Section VI - Communications Tax
A communications service is any electronic transmission of voice, data, audio, video, or other information by or through any
electronic, radio, satellite, cable, optical, microwave or other medium or method regardless of the protocol used for the transmission or
conveyance. Communications services subject to the tax include: landline telephone services (including Voice Over Internet Protocol);
wireless telephone services; cable television; satellite television; satellite radio.
1. Date You Became Liable. Date communications services were provided or anticipated date (MM/DD/YY).
2. Mailing Address if dierent from the Mailing Address in Section I.
Street Address or P.O. Box City, State, ZIP Code
3. Contact Information. If dierent from Primary Contact in Section I, enter contact information for this tax.
Name Title Contact Phone Number
Section VII - Litter Tax
A litter tax is imposed on every business in the state who, on January 1 of the taxable year, was engaged in business as a manufacturer,
wholesaler, distributor, or retailer of certain enumerated products. If you are not in business on January 1, you are not liable for Virginia
Litter Tax until the succeeding year. The products that subject the business to litter tax are: food for human or pet consumption,
groceries, cigarettes and tobacco products, soft drinks and carbonated waters, beer and other malt beverages, wine, newspapers
and magazines, paper products and household paper, glass containers, metal containers, plastic or ber containers made of synthetic
material, cleaning agents and toiletries, non-drug drugstore sundry products, distilled spirits, and motor vehicle parts. This tax does
not apply to individual consumers.
1. Existing Accounts. Enter Virginia Account Number.
2. Date You Became Liable. Date you became liable for Litter Tax (MM/DD/YY).
3. Number of business locations subject to litter tax
4. Mailing Address if dierent from the Mailing Address in Section I.
Street Address or P.O. Box City, State, ZIP Code
5. Contact Information. If dierent from Primary Contact in Section I enter contact information for this tax.
Name Title Contact Phone Number
Page 6