2010 Business License Application Form - City Of Wasilla
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1CITY OF WASILLA
FINANCE DEPARTMENT
290 East Herning Ave., Wasilla, AK 99654-7091
Phone: (907) 373-9088 Fax: (907) 373-9085
2010 BUSINESS LICENSE APPLICATION $25.00
Expiration Date: 12/31/2010
BUSINESS INFORMATION
APPLICATION IS:
Date you will start doing business in Wasilla:________________
New Business:……………………………………..…………..
Renewal…………………………………………………….….
Business Name:_______________________________________
OWNERSHIP:
1. Owner’s Name:_____________________________________
(Check One)
Sole Proprietorship:.......….……………………………………
1. Social Security #:___________________________________
Partnership:(attach agreement if this is a limited partnership)..
LLC:……………………………………………………………
2. Owner’s Name:____________________________________
Non Profit:……(Attach IRS letter)…………..………………..
2. Social Security #:___________________________________
Corporation:……………………………………………………
Alaska Corp#:______________________________________
Employer ID Number (EIN or TIN)_______________________
AK Registered Agent:_______________________________
Mailing Address:______________________________________
BUSINESS LOCATION
PO Box or Street Address
Inside City Limits……………………………………………..
_____________________________________________________
# of Wasilla Locations_________________________________
City
State
Zip Code
Outside City Limits…………..………………………………..
Phone #_____________________Cell #____________________
Line of Business:______________________________________
PHYSICAL LOCATION OF BUSINESS
OTHER BUSINESS LICENSES
Street Address:________________________________________
State of Alaska #:______________________Expires:_________
City, State, Zip Code:___________________________________
Mat-Su Borough #_____________________Expires:_________
*Occupational License #:________________Expires:_________
CONTACT PERSON
*(Required if working in a Specialty occupation.)
(Only if different from Owner/s)
Per WMC 5.16.100, please circle one of the following:
Name:_______________________________________________
A. Sales tax will be included in the sales price.
Phone #______________________________________________
B. Sales tax will be shown separately on the invoice.
IMPORTANT: The fee for a Wasilla Business License is $25.00 to be paid at the time of application. Operating, conducting or carrying on a trade,
business or profession in the city limits of Wasilla without this license is a violation of Title 6.04 of the Wasilla Municipal Code. The code provides
for fines up to $1,000.00.
This license shall not be taken as permission to do business in the State without having complied with the requirements of the laws of the State of
Alaska or the United States. Some activities require a professional license or other federal, state or local permits.
Printed name and title of the person completing the application on behalf of the business.
Printed Name:_______________________________________________________Title:________________________________________________
Signature:___________________________________________________________Received Sales Tax Code
Initials _______ Date:__________
For Office Use Only
Land use permit required per WMC 16. Permit#__________________
Not applicable. Reviewed by:__________________________
Cash/Credit/Check #:________________________Receipt#_____________________Received by:_____________________________________
NAICS Code:_______________BL #:___________________ST #:_____________________License issued by:___________________________
Rev 11/24/09
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Parent category: Business