Application For Occupational License And Sales Tax Registration - City Of Baton Rouge Page 2
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2APPLICATION FOR OCCUPATIONAL LICENSE AND SALES TAX REGISTRATION
4. SOLE PROPRIETOR (Please attach photo identification)
Owner Name:
(Last)
(First)
Mailing Address:
-
City
State
Zip Code
Phone Number:
(
)
Social Security No.:
5. CORPORATIONS, LIMITED LIABILITY, AND LIMITED PARTNERSHIPS (For incorporated and limited partnerships only.
If incorporated, attach a copy of your State Charter Certificate. Please attach a separate page listing of all officers and partners with
this corporation.)
Legal Name:
First Name (If other than the corporation)
Last Name
Trade Name:
Agent of Record:
(First)
( Last)
Service Address:
-
City
State
Zip Code
CONTACT PERSON:
TITLE:
PHONE NO.
State of Record:
Type of
CORP - Corporation GOVT - Government
LTDP - Limited Partnership
NONP - Non-Profit
Organization:
PTNR - Partnership
OWNR - Sole Proprietorship UNKN - unknown LLC - Limited Liability Co.
Date of
Organization:
/
/
Year
Month
Day
Louisiana Tax ID#:
Federal Tax ID#:
I CERTIFY THAT, TO THE BEST OF MY KNOWLEDGE, THE ABOVE INFORMATION IS TRUE AND CORRECT.
Signature of Owner, Agent, Officer
Title
Date
FOR OFFICE USE ONLY
FILING
MAIL
7. ACCOUNT STATUS
TAX CODE
FREQ.
RETURNS
Business Code:
Tax Types:
Registration Type:
Termination Type:
Registration Method:
Stopped Operating:
Special Access:
(Liquor License)
Transferred From:
(Account Number)
Transferred To:
PROCESSED BY:
Revenue Agent
Date
KEYPUNCHED BY:
Revenue Agent
Date
VERIFIED BY:
Revenue Agent
Date
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