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City of Portland
Revenue Bureau
111 SW Columbia ST # 600
Portland OR 97201-5840
Office: (503) 823-5157
NEW ACCOUNT #
FAX: (503) 823-5192
( (
Reset Form
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INITIAL EXEMPTION APPLICATION
If your business is exempt from paying the City of Portland Business License and Multnomah County
Business Income Tax, you are required to complete this form and return it to our office. No license will
be issued. If you need a business license, complete an application for Portland Business License and
pay the $100 minimum fee. Exemptions are valid for one year and must be renewed annually.
SOME OF THE INFORMATION PROVIDED ON THIS FORM MAY BE SUBJECT TO DISCLOSURE UNDER PUBLIC RECORD LAW
NAME:
1)
PRINT name of business owner(s), partnership or corporation – as filed on the Oregon tax return.
BUSINESS NAME/Doing Business As (DBA): [If different from above NAME]
3) BUSINESS CODE (NAICS)
2)
4) BUSINESS CONTACT NAME:
TITLE:
CONTACT PHONE:
(
)
Is this person authorized to represent the licensee?
Yes
No
TAX ENTITY:
Sole Proprietor
Partnership
Corporation
S – Corporation
(check one)
Trust
Ltd. Liability Co*.
Ltd. Partnership
Estate
Other:
(*If single member LLC, please also check parent/filing entity)
5) FISCAL YEAR
BUSINESS FAX:
6) TAX ENTITY ID # (Not subject to disclosure)
END:
(
)
F.E.I.N:
SS #:
7) NUMBER OF
8) DATE BUSINESS
9) Is business activity performed outside Portland?
OWNERS:
ACTIVITY BEGAN IN
Yes
No
CITY/COUNTY:
(MM/DD/YY)
10) Is this a new business?
Yes
No
IF business previously licensed, name of previous owner:
11) PRIMARY BUSINESS ADDRESS: (location)
Number/Street - NOT PO BOX
City, State, Zip Code
12) BUSINESS ACTIVITY DESCRIPTION:
PROPERTY TYPE: Is business address on:
BUSINESS PHONE: (
)
COMMERCIAL
RESIDENTIAL property?
MAILING ADDRESS:
13)
(If different from line 11 above)
COMPLETE BOTH SIDES and SEND FORM to:
CITY OF PORTLAND, 111 SW COLUMBIA ST, SUITE 600, PORTLAND, OREGON 97201-5840
Form IEA (revised 1/31/08)