CITY OF UNIVERSITY PLACE
APPLICATION FOR CERTIFICATE OF REGISTRATION FOR ADMISSIONS TAX
FOR YEAR ENDING DECEMBER 31, 2000
Legal Name______________________________________________ FIN/SSN_____________________
Trade Name____________________________________________________________________________
Business Location Address________________________________________________________________
City______________________________
State_________________
Zip Code______________
Business Location Telephone Number (___)___________________________
MAILING ADDRESS IF DIFFERENT FROM PHYSICAL ADDRESS:
Mail License to:_________________________________________________________________________
City______________________________
State_________________
Zip Code______________
Telephone Number (___)_______________________________
Type of Activity or Event:_________________________________________________________________
Indicate Type of Ownership:
(
) Individual
(
) Partnership
(
) Corporation
LIST OWNERS, PARTNERS, OR CORPORATE OFFICERS:
Name & Title
Residence Address
Residence Phone
__________________________
____________________________________
(
) ______________
__________________________
____________________________________
(
) ______________
__________________________
____________________________________
(
) ______________
FINANCIAL RESPONSIBILITY:
Accountant/Bookkeeper__________________________________________________________________
Individual(s) responsible for collection and payment of tax_______________________________________
Individual(s) responsible for day-to-day management___________________________________________
I hereby certify that the statements contained herein are true and correct.
Date:_____________________
Signature of Applicant:______________________________________
Title:_____________________
Printed Name of Applicant:___________________________________