ible for its content.
AP-142 Machine Location Amendment for Registration Certificate Holders AP-142

(Rev.4-04/6)

MACHINE LOCATION AMENDMENT
FOR REGISTRATION CERT
IFICATE HOLDERS
The Coin-Operated Machines Law (Occupations Code 2153.158) requires that the holder of a

Registration Certificate shall indicate the name and location address of each machine, and certify

that a valid tax permit is affixed to each machine.

For Comptroller Use Only
00990
4420
If you move any machine during the year, you are required to complete this amendment form and

return it to the Comptrollers Office within 10 days of the move. (Occupations Code 2153.160)

NOTE: You must complete a separate form for each location to which you moved machines and list the machines moved to that location.
TYPE OR PRINT
DO NOT WRITE IN SHADED AREAS
YES
NO
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NO
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NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
DATE THE
MACHINE WAS
MOVED
MACHINE
SERIAL NUMBER /
INVENTORY I.D. NUMBER
MACHINE MAKE OR MANUFACTURE
MACHINE
TYPE CODE
(Use letter code from below.)
VALID
TAX PERMIT
AFFIXED?
5. For each machine moved to this location, list the date moved, serial number / inventory I.D. number, make, type, and check if the machine has
or does not have a valid tax permit affixed.
1. Legal name of owner
(Sole owner, partnership, corporation, or other name)
Taxpayer number
2. Mailing address
(Street & no, P.O. Box or Rural Route and box no.)
City
State
ZIP code
County
3. Trade name of your business where machine(s) has been relocated
Phone
(Area code and number)
4. Location of this business
(Use street & no. or directions. P.O. Box or Rural Route NOT acceptable)
City
State
ZIP code
County
T
A
X
P
A
YER INFORMA
TION
MACHINE LOCA
TION
INFORMA
TION
MACHINE INVENTORY LIST
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Sole owner, partner, or officer
Date
A
- PHONOGRAPHS
B
- POOL TABLES
C
- PINBALL GAMES
D
- VIDEO GAMES
E
- DARTS
F
- OTHER
If additional space is needed, add supplemental pages.
I certify that all information in this amendment is true and correct.
Mail to: TEXAS COMPTROLLER OF PUBLIC ACCOUNTS
111 E. 17th Street
Austin, TX 78774-0100
FOR ASSISTANCE - If you have any questions about this application, contact your
nearest Texas State Comptrollers Office or call us toll free at 1-800-252-1385. The
local number in Austin is 512/463-4600. If youre calling from a Telecommunications
Device for the Deaf (TDD), call 1-800-248-4099. The Austin TDD number is 512/463-
You have certain rights under Ch. 559, Government Code, to review, request, and
4621. The Tax Help E-mail Address is: tax.help@cpa.state.tx.us
correct information we have on file about you. Contact us at the address or toll-free number
listed on this form.
Field office number
E.O. name
User ID
Date