Application For Transaction Privilege (Sales) Tax License Form Arizona

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City of Nogales
License No. ____________________
Issued By:______________________
Finance Department
Filing Status:____________________
Business Code:__________________
777 N. Grand Avenue
SIC Code:______________________
For Office Use Only
Nogales, Arizona 85621
APPLICATION FOR TRANSACTION PRIVILEGE (SALES) TAX LICENSE
A $25.00 non refundable fee is due at the time of application and renewable annually
BusinessName:_____________________________________________________________________________
MailingAddress:___________________________________________________________________________
(street)
(city)
(state)
(zip)
BusinessLocation:__________________________________________________________________________
(street)
(city)
(state)
(zip)
Business Phone: (_____)________________________ Business Start Date:__________________________
Business Type:
Contractor
Retail
Rental
Other
Brief Description of Business Type:___________________________________________________________
(If contractor attach copy of contractors license)
State Sales Tax License Number:______________________ Federal I.D. Number:___________________
Type of Ownership:
Individual
Partnership
Corporation
Owner, Partner, or Officer
Title
Home Address & Phone
SS#
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Location of Records for Audit Purposes:_______________________________________________________
Landlord Name & Address:__________________________________________________________________
Did you Purchase a Business or Relocate your Previous Business?
Yes
No
If Yes, List the Following Information:
__________________________________________________________________________________________
(Previous Business Name)
(Address)
(Phone)
(Former License Number)
NOTICE: If you purchased this business, be sure all taxes have been paid by the former business and a
tax clearance has been issued by the City of Nogales. Under the law you may be held liable for any
unpaid taxes due.
I HEREBY CERTIFY THAT ALL STATEMENTS ANSWERED ON THIS FORM ARE TRUE AND COMPLETE
_____________________________________________
__________________________
(Signature of Owner, Partner or Officer)
(Date)

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