Application For Business Identification Number (License & Taxes) - City Of Robertsdale, Alabama

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CITY OF ROBERTSDALE, ALABAMA
APPLICATION FOR BUSINESS IDENTIFICATION NUMBER (LICENSE & TAXES)
COMPLETE AND RETURN THIS FORM TO:
City of Robertsdale
P. O. Box 429
Robertsdale, Alabama 36567-0429
251.947.8920 FAX 251.947.1129 TDD 251.947.2122
e-mail:
PLEASE PRINT OR TYPE
DATE OF APPLICATION __________________
NAME OF TAXPAYER (LAST, FIRST, MI)
TRADE NAME IF DIFFERENT THAN NAME OF TAXPAYER (DBA)
_________________________________________________
________________________________________________
MAILING ADDRESS TO WHICH TAX FORMS ARE TO BE SENT:
LOCATION PHYSICAL ADDRESS
(IF A POST OFFICE BOX, STREET NUMBER MUST ALSO BE SHOWN)
ATTENTION: ______________________________________________
ATTENTION: ______________________________________________
_________________________________________________________
________________________________________________________
_________________________________________________________
________________________________________________________
CITY_______________________ STATE ____ ZIP _______________
CITY_______________________ STATE ____ ZIP _______________
E-MAIL ADDRESS: _________________________________________
E-MAIL ADDRESS: _________________________________________
PHONE # (_____)______-________ FAX # (_____)______-________
PHONE # (_____)______-________ FAX # (_____)______-________
TYPE OF BUSINESS:
FORM OF ORGANIZATION:
___ 1. Manufacturer
___ 5. Retailer (Product) _______________
___ 1. Corporation
___4. Professional Assocaition
___ 2. Contractor
___ 6. Rental
___ 2. Partnership
___5. LLC
___ 3. Wholesaler
___ 7. Other _________________________
___ 3. Proprietorship
___6. Other _________________________
___ 4. Home Occupation -
Robertsdale city limits residential (see attached)
PRINCIPAL BUSINESS ACTIVITY AND PRODUCT THAT ACCOUNTED FOR THE LARGEST
DATE BUSINESS BEGAN IN ROBERTSDALE:
PERCENT OF GROSS INCOME.
(SUCH AS -- WHOLESALE - APPAREL or RETAIL - APPAREL)
MONTH ____________
DAY_________ YEAR ________________
ACTIVITY ___________________ PRODUCT____________________
Does this location have any coin-operated vending machines? (____) Yes (____)No
If yes, give the number and types of machines below.
____________________________________________________________________________________________________________________
PHYSICAL LOCATION FOR ZONING REQUIREMENTS:
Are hazardous materials used at this location? ___Yes
___ No
___ 1. Inside City Limits of Robertsdale - Business or Residential
NOTE: Any City Limits location requires Zoning Department approval
___ 2. Outside City Limits but Inside Police Jurisdiction of Robertsdale
to insure compliance with city zoning requirements.
___3. Outside City Limits and Police Jurisdiction of Robertsdale
* ZONED: _____________
TYPE OF USE: ______________________
*****************CITY USE ONLY****************************************************USE ALLOWED BY RIGHT: ____YES
____NO
APPROVED: _____________________________________________
USE REQUIRING A SPECIAL EXCEPTION BY ZBA: ____YES ____NO
USE REQ. APPROVAL BY PLANNING COMMISSION: ____YES ____NO
NOT APPROVED: _________________________________________
********** NOTE: SIGNATURE OF ZONING OFFICIAL REQUIRED IF IN CITY LIMITS FOR BUSINESS LICENSE TO BE ISSUED.*************
CHECK THE TAXES FOR WHICH YOU ARE LIABLE:
TAX IDENTIFICATION NUMBER NOW ASSIGNED TO YOU
__ SALES TAX
__ BEER TAX
Federal I. D. Tax Number: ___________________________________________________
__ SELLERS USE TAX
__ WINE TAX
State of Alabama Tax Number: ______________________________________________
__ LEASE/RENTAL TAX
__ LIQUOR TAX
State of Alabama Contractor (Subcontractor) License Number: ____________________
__ CONSUMER USE TAX
__ TOBACCO TAX
Robertsdale Business License Number: ______________________________________
__ BUSINESS LICENSE
__ GASOLINE TAX
Robertsdale Taxpayer Identification Number: __________________________________
IF YOU MAKE DELIVERIES OR SALES INTO THE CITY'S TAXING JURSIDICTION, INDICATE THE METHOD
GROSS RECEIPTS: ___________________
LICENSE AMOUNT _________________
BELOW UNDER SALES METHOD AND DELIVERY METHOD. (THIS IS FOR OUT OF CITY APPLICANTS.)
SALES METHOD:
DELIVERY METHOD:
ISSUANCE FEE
+
$5.00
__ Salesman
__Mail Order
__ Own Vehicle
__Common Carrier
PENALTY
____________________
__ Commission
__Telephone Order only
__ Customer Pick-up
__ UPS
CITATION
____________________
__ Other_________________________________
__ Other__________________________
TOTAL LICENSE & FEES _____________
OFFICERS, PARTNERS OR OWNERS
NAME
HOME ADDRESS
SOCIAL SECURITY #
TITLE
______________________________
_______________________________________________
___________________
_____________
______________________________
_______________________________________________
___________________
_____________
______________________________
_______________________________________________
___________________
_____________
______________________________
_______________________________________________
___________________
_____________
______________________________
_______________________________________________
___________________
_____________
________________________________________________
__________________________ _____________________
Signature (Owner/Officer)
Title
Date

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