Application For Certificate Of Registration Form - City Of Tacoma printable pdf download

City of Tacoma

Sent By______________ Date______________

Finance Department/Tax & License Division

733 Market Street, Room 21, Tacoma, WA 98402-3770

(253) 591-5252

Contract Account _______________________

APPLICATION FOR CERTIFICATE OF REGISTRATION

See reverse side of yellow copy for general requirements. Title 6 of the Tacoma Municipal Code, as amended.

Yes

Have you ever been registered as a business with the City of Tacoma? If yes, when? ______________________________________

❐

Previous business name _____________________________________ Previous location ______________________________________________

Yes

Purchasing an existing business? (Please indicate Name, Address & Telephone Number of previous owner).

❐

_________________________________________________________________________________________________________________________

_________________________________________________________

File Number __________________________________________________

TO ENSURE YOUR BUSINESS MEETS CITY ZONING REQUIREMENTS CONTACT BUILDING & LAND USE SERVICES AT (253) 591-5577

Sole owner ❐ (Check if operated by husband and wife ❐) ______________________________________ Date of birth____________

Full legal name of owner _____________________________________________________________________ SSN ___________________

Full legal name of spouse ____________________________________________________________________ SSN ___________________

Home address ____________________________________ City ________________________State ______ Zip ____________________

Telephone __________________________ Home Fax _______________________________ Work Phone ________________________

Nearest relative ____________________________________________________________________________________________________

(full name, address and telephone number)

LLC ❐ Partnership ❐ Corporation ❐

Name of LLC, partnership, or corporation ______________________________________________________________________________

Registered agent ______________________________________________________________________________________________________

(full name, address and telephone number)

Complete full name, address and telephone number of partners or officers on reverse of white original.

Business Phone # _______________________________________________ Business Fax # _____________________________________________

Cell/Pager # ___________________________________________________ E-Mail Address _____________________________________________

Physical location__________________________________________________________________________________________________________

(# & street — DO NOT use PO Box or Mail Drop)

City_____________________________________________________ State _________ Zip ____________________

If current Tacoma Public Utility customer, please provide utility account # ______________________________________

Mailing Address ______________________________________________ City ___________________________ State ______ Zip ____________

State UBI # ___________________________ Federal EI # ____________________ State Professional License #___________________

Name of Business (dba)__________________________________________________________________________________________________________________

Describe in detail principal product or service provided ________________________________________________________________________________

_________________________________________________________________________________________________________________________________________

Opening Date (Date business activity commenced in or with the City of Tacoma)_______________________________________________________

Is business located in the City of Tacoma? Yes ❐ No ❐ If yes: # of Full-time Employees _______________ Sq. Ft. of Location __________

What do you anticipate your business gross receipts** for an entire year to be? $ ________________________________________

(**Gross Receipts: Total business income shall include all income from business activities both within and without the corporate city limits of Tacoma.)

Is your organization recognized as a 501 (c) (3) non profit organization by the Internal Revenue Service? *Yes

❐

* If yes, you must submit a copy of your 501 (c) (3) status letter from the Internal Revenue Service

Additional Locations (Branches) in Tacoma? Yes ❐ No ❐ If yes, separate Tax Returns are required for each branch location.

Name under which operating _____________________________________________Location _________________________________________

Do you provide gambling activities? Yes ❐ No ❐

Do you own or operate any of the following mechanical devices?

Amusement Yes ❐ No ❐ Music Yes ❐ No ❐ Pool Table Yes ❐ No ❐

General licenses applicable to your business ______________________________________________________________________________

(See reverse side of form for general license information)

The undersigned hereby certifies that the information shown is correct to the best of his/her knowledge and belief under penalties of perjury.

Signed by __________________________________________________

___________________________________________________________

(Owner, partner or officer)

(Date)

(Signature of preparer if other than owner, partner or officer)

Title

(Preparer address)

(Date)

❐

OFFICE USE ONLY TYPE OF ID:

WDL

WID

MIL

OTHER ______________________________________ ID# _________________________

❐

SIC_____________ Classes______ ______ ______ ______ ______ NR

ABLs Year & Amt. Paid ____________________________________________

Forms Sent _______________________________________________________

(Date & Initial)

Taxes Paid ______________________________________________________

Incomplete Application Returned ___________________________________

(Date & Initial)

Licenses ________________________________________________________

System Entry _____________________________________________________

(Date & Initial)

TXL 184_05 (06/09) t

Application For Certificate Of Registration Form - City Of Tacoma

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