Free AP-168 Customs Broker License Application - Texas

TEXAS APPLICATION FOR CUSTOMS BROKER LICENSE

SUSAN COMBS · COMPTROLLER OF PUBLIC ACCOUNTS
GENERAL INFORMATION
WHO MAY SUBMIT THIS APPLICATION If you have been licensed by the United States Customs Service, you may submit this application to receive your Texas Customs Broker License. You must include a copy of your United States Customs Broker's license. DEFINITIONS United States Customs Broker - A person licensed by the United States Customs Service to act as a custom house broker. Texas Customs Broker License - The license issued to the United States Customs Broker, to allow the broker to issue export certifications. A license is required for each business location. Authorized Employee - "Authorized employee" means an employee of a customs broker: (A) who is authorized by the broker to perform customs transactions on behalf of the broker; (B) who is compensated by the broker with a regular salary or wages; (C) who is under the direct control and supervision of the broker; and (D) from whose salary or wages the broker is required to and actually does deduct and withhold a tax under federal law. Business Location - Each place of business of the broker where export certification forms are fully or partially prepared. Export Certification Stamp - Stamp that is affixed to the export certification form. BROKER FEES Broker Annual License Fees (The Customs Broker License expires on December 31 of each calendar year). License must be renewed on or before December 31 of each year. ANNUAL LICENSE FEE SCHEDULE 1st Quarter (January - March) ............................... $300.00 2nd Quarter (April - June) ....................................... $225.00 3rd Quarter (July - September) ............................... $150.00 4th Quarter (October - December) ........................... $ 75.00

NOTE: A license fee is due for each business location where export certifications will be issued. BOND FEE The amount of the bond or security required is $5,000. (The Comptroller may require Brokers to post additional $1,000 bond or security for each location, if the Comptroller considers it necessary to ensure payment of tax, penalty and fine amounts.) STAMP FEE The Comptroller shall charge $1.60 for each stamp. FOR ASSISTANCE If you have any questions about this application, or any other related matter, contact your nearest Texas State Comptroller's office. You may also call (800) 252-5555 or (512) 463-4600. Spanish speaking assistance is available upon request. GENERAL INSTRUCTIONS · · · · Please type or print. Do not separate pages. Fill in all blanks and answer all questions completely and fully. Completed application and payment (made payable to State Comptroller) should be mailed to: Comptroller of Public Accounts 111 E. 17th Street Austin, TX 78774-0100 NOTE: No export certifications may be issued until you provide a copy of your United States Customs Broker's License, this application has been approved and your Texas Customs Broker License has been issued.
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. You have certain rights under Ch.559, Government Code, to request, review and correct information we have on file about you. Contact us at the address or phone numbers listed on this form.
AP-168-1 (Rev.7-09/3)

AP-168-2 (Rev.7-09/3)

TEXAS APPLICATION FOR CUSTOMS BROKER LICENSE
· TYPE OR PRINT

PRINT FORM

CLEAR FORM

· PLEASE READ INSTRUCTIONS

· DO NOT WRITE IN SHADED AREAS

Page 1.

1. LICENSED CUSTOMS BROKER AGREEMENT - The applicant, in consideration of the issuance of the Texas Customs Broker License, agrees and affirms: a. that the applicant is a responsible Licensed Customs Broker issuing valid export certifications for merchandise being exported from the United States; b. that the export certifications will not be used in a manner that violates a provision of the Tax Code or the Comptroller's rules; c. that a copy of the applicant's United States Customs Broker's license is provided to the Texas Comptroller of Public Accounts at the time of application; d. that the Comptroller of Public Accounts may suspend or revoke a Texas Customs Broker's license to issue export certifications under this section for good cause; e. to properly document the issuance of export certifications and stamps, and to purchase new stamps as described in the Comptroller's rules; f. that upon request, the licensed Customs Broker will make records available to the Comptroller or his authorized representative in the State of Texas and will cooperate with the Comptroller or his authorized representative in the examination of the records; g. that copies of each employee's power of attorney to issue export certifications in the name of the applicant are included; h. information in this document and any attachments is true and correct to the best of my knowledge and belief; and i. I understand that computer system passwords are confidential. I will not disclose (to any person) any password(s) which I am given or devise, and I will not write down such password(s) or post them where they may be viewed by others. I understand that I am responsible for any computer transactions performed as a result of access authorized by use of any passwords that I receive or devise. I agree to abide by all written conditions and restrictions imposed by the Comptroller's Information Security Office. I agree NOT to attempt to circumvent the Comptroller's computer security system. I understand that use of a password not issued specifically to me or to a group of which I am a member is expressly prohibited. I also understand that failure to observe these restrictions may constitute a Breach of Computer Security, and that such an offense may constitute a first-degree felony. Tex. Pen. Code §33.02.
Type or print name of licensed customs broker Broker, officer or authorized agent Date of application

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.TexasOnline.com/portal/tol/en/9/1. You may also want to contact the municipality and county in which you will conduct business to determine any local governmental requirements. 2. Legal name of applicant as registered with the United States Customs Service
For Comptroller's use only

00991
Reference no.

Tax type/reason

9 2 2 0

3. Mailing address where you will receive mail from the Texas Comptroller of Public Accounts
Street and number, P.O. Box or rural route Taxpayer number

XAMAST
County code

City

State

County

ZIP/Postal Code

·
Master phone num add/change

XUMAST 4. Enter your Social Security number if you are a sole owner ..................................... 5. Enter your Federal Employer Identification Number (FEIN), if any ................... 6. Daytime phone where applicant may be reached (Area code and number) ...

1

Secondary mailing address set-up

XAADDR

(

)

Secondary mailing address change

XUADDR
Tax type

7. Enter the number of the license issued by the United States Customs Service ............................................ 8. Enter your Texas taxpayer number for reporting any Texas tax or your Texas Vendor Identification Number if you now have or have ever had one ............

· 092
County code

·
9. Enter your e-mail address ...... 10. If your business is a corporation, list all principal officers. (Attach additional sheets as necessary.)
Name Home address SSN or FEIN E-mail address City Title Phone (Area code and number)

(
State

)
ZIP Code

Name Home address SSN or FEIN E-mail address City

Title

Phone (Area code and number)

(
State

)
ZIP Code

AP-168-3 (Rev.7-09/3)

TEXAS APPLICATION FOR CUSTOMS BROKER LICENSE
· TYPE OR PRINT · DO NOT WRITE IN SHADED AREAS
Texas Customs Broker license number

· PLEASE READ INSTRUCTIONS
11. Legal name of applicant (Same as Item 2)

Page 2.

· Complete the following information for each active business location where export certifications will be issued. (Attach additional sheets as necessary.)
12. Business name

Outlet/location set-up

XALOCA
Location number

13. Business location (Street and number--do not use P.O. Box or rural route)

·
County
County code

City

State

ZIP Code

T X
14. Is your business located inside the boundaries of an incorporated city? .................................................................
Month

·
YES
Day

NO
Year

ICL/OCL

·
Y or N Add responsibility

15. First business date ............................................................................................................................................ 16. Business phone (Area code and number) .......................................................................... 17. Business name

(

)

XASTAT

Outlet/location set-up

XALOCA
18. Business location (Street and number--do not use P.O. Box or rural route)
Location number

·
City State ZIP Code County
County code

T X
19. Is your business located inside the boundaries of an incorporated city? .................................................................
Month

·
YES
Day

NO
Year

ICL/OCL

·
Y or N Add responsibility

20. First business date ............................................................................................................................................ 21. Business phone (Area code and number) ..........................................................................

(

)

XASTAT
Outlet/location set-up

22. Business name

XALOCA
23. Business location (Street and number--do not use P.O. Box or rural route)
Location number

·
City State ZIP Code County
County code

T X
24. Is your business located inside the boundaries of an incorporated city? .................................................................
Month

·
YES
Day

NO
Year

ICL/OCL

·
Y or N Add responsibility

25. First business date ............................................................................................................................................ 26. Business phone (Area code and number) .......................................................................... 27. Business name

(

)

XASTAT
Outlet/location set-up

XALOCA
28. Business location (Street and number--do not use P.O. Box or rural route)
Location number

·
City State ZIP Code County

T X
29. Is your business located inside the boundaries of an incorporated city? .................................................................
Month

County code

·
YES
Day

NO
Year

ICL/OCL

·
Y or N Add responsibility

30. First business date ............................................................................................................................................ 31. Business phone (Area code and number) ..........................................................................

(

)

XASTAT

AP-168-4 (Rev.7-09/3)

TEXAS APPLICATION FOR CUSTOMS BROKER LICENSE
· TYPE OR PRINT · DO NOT WRITE IN SHADED AREAS
Texas Customs Broker license number

· PLEASE READ INSTRUCTIONS
32. Legal name of applicant (Same as Item 2)

Page 3.

· Complete the following information for every employee authorized to issue certifications. A power of attorney is required for each employee authorized to issue certifications. Include any officers that will issue certificates. (Attach additional sheets as necessary.)
33. Name of employee (First name, middle initial, last name) 34. Social Security number
Master set-up

35. Home address (Street and number, P.O. Box or rural route)

XAMAST
County code

City

County/Country

State/Province ZIP/Postal Code

·
Month Day Year

36. Beginning date ................................ 37. E-mail address 39. Name of employee (First name, middle initial, last name)

Employee Taxpayer No. 38. Phone number (Area code and number)

Related Party

ADD

(

)
40. Social Security number
Master set-up

41. Home address (Street and number, P.O. Box or rural route)

XAMAST
County code

City

County/Country

State/Province ZIP/Postal Code

·
Month Day Year

42. Beginning date ................................ 43. E-mail address 45. Name of employee (First name, middle initial, last name)

Employee Taxpayer No. 44. Phone number (Area code and number)

Related Party

ADD

(

)
46. Social Security number
Master set-up

47. Home address (Street and number, P.O. Box or rural route)

XAMAST
County code

City

County/Country

State/Province ZIP/Postal Code

·
Related Party

Month

Day

Year

48. Beginning date ................................ 49. E-mail address 51. Name of employee (First name, middle initial, last name)

Employee Taxpayer No. 50. Phone number (Area code and number)

ADD

(

)
52. Social Security number
Master set-up

53. Home address (Street and number, P.O. Box or rural route)

XAMAST
County code

City

County/Country

State/Province ZIP/Postal Code

·
Month Day Year

54. Beginning date ................................ 55. E-mail address 57. Name of employee (First name, middle initial, last name)

Employee Taxpayer No. 56. Phone number (Area code and number)

Related Party

ADD

(

)
58. Social Security number
Master set-up

59. Home address (Street and number, P.O. Box or rural route)

XAMAST
County code

City

County/Country

State/Province ZIP/Postal Code

·
Related Party

Month

Day

Year

60. Beginning date ................................ 61. E-mail address

Employee Taxpayer No. 62. Phone number (Area code and number)

ADD

(

)