Business License Application Form - City Of Moreno Valley
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1
2City of Moreno Valley
Please Check One
New Application
q
14177 Frederick Street • P.O. Box 88005 • Moreno Valley, CA 92552-0805
Phone: 951.413.3080 • Fax 951.413.3096
Change of Address
q
BUSI NESS LICENSE APP LICATION
Change of Business Name
q
PLEASE TYPE OR PRINT CLEARLY:
Business Name
Business Location
(No P. O. Box)
City
State
Zip
Mailing Address
(If Different)
Health Permit No.
City
State
Zip
Pager No. (
)
Bus. Phone (
)
Bus. Fax (
)
No. of Employees
(F/T)
(P/T)
E-Mail Address
Ownership:
q Corporation
Ltd. Liability Corp.
q Partnership
q Sole Proprietor
q Trust
q
Date business started:
Description of Business:
State Lic. No.
License Type
Expiration Date
Resale No.
Federal I.D. No.
State I.D. No.
ENTER BELOW NAMES OF OWNERS, PARTNERS, OR CORPORATE OFFICERS - Attach additional page if necessary
Corporate or Owner Name
Title
Phone (
)
Home Address
Cell Phone (
)
City
State
Zip
Social Security No.
Driver’s License No.
Date of Birth
Corporate or Owner Name
Title
Phone (
)
Home Address
Cell Phone (
)
City
State
Zip
Social Security No.
Driver’s License No.
Date of Birth
EMERGENCY CONTACT:
Name
Title
Phone (
)
Address
Cell Phone (
)
CALCULATE GROSS RECEIPTS TAX: Office Use Only
If your surname is not included in the name of
$
(1) Enter current year’s Gross Receipts
your business, you will need proof of a fictitious
name registration and publishing or articles of
(2) Gross Receipts Tax Rate
incorporation.
$
(3) Gross Receipts Tax Due
If your business requires a resale number or any
$
(TOTAL of line 1 x line 2)
type of license or permit, you will need to provide
documentation that you have completed these
CALCULATE TOTAL OF FEES AND TAX DUE:
required actions.
55.00
Required Processing Fee
$
All of the above requirements must be completed
Gross Receipts Tax Due
$
(ENTER AMOUNT FROM LINE 3 ABOVE;
before processing of the business license application
IF LINE 3 ABOVE IS $99.99 OR LESS, ENTER ZERO)
can be initiated.
No. of business vehicles ______ x $6.00
$
All businesses are subject to audit.
$
TOTAL AMOUNT DUE
I hereby certify, under penalty of perjury, that the information in this application is true, correct, and complete to the best of my knowledge
and belief. I agree to comply with all applicable laws and ordinances regulating the operation of this business.
Signature of Owner or Representative:
Date:
RETURN COMPLETED APPLICATION FORM TO ABOVE ADDRESS WITH A CHECK MADE PAYABLE TO THE CITY OF MORENO VALLEY
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Parent category: Business