DEPARTMENT OF FINANCE

Division of Revenue

Statutory Authority: 30 Delaware Code, Section 354 (30 Del.C. §354)

GENERAL NOTICE

Delaware's Voluntary Tax Compliance Initiative (VTCI) (September 1, 2009 - October 30, 2009)

To be considered for the tremendous benefits of the VTCI program you will need to register by completing the information below. Mail in this form with your payment or complete via phone or online.

REGISTRATION FORM

Name :_______________________________________ (please print)

1. Home Phone:______________________________

2. Alternative Phone:__________________________

3. TaxPayerID#:______________________________

4. Status (circle one)

1 First Time Filer in Delaware

2 Return(s) may be missing

3 Return(s) may need correction

5. Repayment(circle one)

1 NOT currently paying a liability

2 In current Repayment plan

3 Current Wage Garnishment or lien

6. If you are planning to file a non-filed or amended return for returns that were previously filed, you must complete this section.

(Non-filed or amended returns for the VTCI must be received no later than October 30, 2009 to qualify).

TAX Type

TAX YEAR(S)

If New/Amended Return, Estimated Tax Amount

Personal income tax

   

Withholding tax

   

Gross receipts tax

   

Estate tax

   

Income tax on estates and trusts

   

Corporation income tax

   

Occupational license fees and tax

   

Contractors’ license fees and tax

   

Manufacturers’ license fees and tax

   

Tobacco product license fees and tax

   

Realty Transfer tax

   

Public Utilities tax

   

Lodging tax

   

Retail and Wholesale Merchants’ license fees and tax

   

Use tax and gross receipts tax on leases of tangible personal property

   

(The above-listed taxes due from partners, shareholders or members of pass-through entities filing a voluntary tax return are also eligible.)

7. Confirm your existing reported liabilities below that you would like to register into the VTCI program

– make changes/additions where needed. (These are amended return claim liabilities)

Tax Type

Period/Year(s)

Amt Reported Due

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

(use additional space below if needed)

Authorized Signature ___________________________ Date ______________________

Telephone Number _______________________ Email ___________________________

Tax Payer Name : ____________________________

Business Name: _____________________________

Address : _______________________________

_______________________________

13 DE Reg. 517 (10/01/09)