Privilege License Tax/business License Application - City Of Avondale
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1PLEASE INCLUDE $25.00 APPLICATION FEE & $40.00 ANNUAL LICENSE FEE FOR PERMANENT LICENSE
PRIVILEGE LICENSE TAX/BUSINESS LICENSE APPLICATION
(Sales Tax Rate 2.5% Use Tax Rate 1.5%)
PLEASE PRINT OR TYPE
THIS APPLICATION MUST BE FILED BEFORE YOU CAN ENGAGE IN BUSINESS IN THE CITY OF AVONDALE
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a
Check one:
Special event (Sponsored by non-profit organization) $15.00 a day: maximum of 3 days
Permanent
For Office Use Only
Name of event and dates: _________________________________________________________
App. Fee
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Check one:
New Business
Former Owner (if applicable)
Previous City License #
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New Owner of Existing Business
License Fee
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Check any
Name Change Only
Current City License #
Date of Change
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that apply:
Location Change
License #
SECTION I. BUSINESS INFORMATION
SIC Code
Business Name (Individual, Company or “DBA”, first name first)
Business Class
Street No.
(N,E,S,W)
Street Name
Type
Ste/Apt #
-
-
City
State
ZIP Code + 4
Area Code
Business Telephone #
Approvals
Fire Department
-
Start Date
Email address
State License #
Federal ID #
Zoning
SECTION II. MAILING ADDRESS & PHONE NUMBER
Building
Enter Name if Different from Section I (above) or Enter “In-Care-Of” Name
Police Department
Street No.
(N,E,S,W)
Street Name
Type
Ste/Apt #
City Clerk
-
-
City
State
ZIP Code + 4
Area Code
Telephone #
SECTION III. BUSINESS OWNERSHIP & RECORD LOCATION
Comments
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Ownership:
Individual
LLC
Corp. - State Inc. __________
Gen. Partnership
Ltd. Partnership
Other ________________
1)
Name
Title
Owners, Partners,
Home Address
Social Security #
LLC Members, or
Officers
City
State
ZIP Code
Phone No.
(
)
(For Additional Names,
Please Attach List)
2)
Name
Title
Individuals Must Provide
Home Address
Social Security #
Proof of Legal Residence
City
State
ZIP Code
Phone No.
(
)
Corporate or LLC
Name
Phone No.
(
)
Statutory Agent
Name
Phone No.
Location Where
(
)
Business Records
Address
City
State
ZIP Code
Are Kept
SECTION IV. BUSINESS TYPE
Business Type
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Retail Sales
Wholesaler
Amusement
Construction Contracting
Use Tax
Restaurant/Bar
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Manufacturer
Commercial Rental
Residential Rental (# of Units _______ )
Hotel/Motel
Other ____________
Describe Nature of
Contractors #
Business
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Check method you will use in submitting reports:
Cash Receipts
Accrual
# of Employees
SECTION V. BUSINESS PREMISES STATUS
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Check one:
Do you own your business location?
Yes
No
If yes, is this your residence?
Yes
No
If no, complete Landlord/Property Manager Information
Landlord/Property Manager Name
Address
Phone No.
(
)
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a
Do you rent a portion of the business premises to another entity?
Yes
No
I certify that the statements made in this application are true and complete to the best of my knowledge. I accept the license authorized and issued in response to this
application with the condition that I report timely and pay any and all taxes due by me to the city. Incomplete forms may not be processed.
IF APPLICABLE, BE SURE ALL SALES TAX HAS BEEN PAID BY FORMER OWNER, BY LAW YOU MAY BE LIABLE FOR ANY UNPAID TAX.
Print Name
Signature
Title
Date
CITY OF AVONDALE, ATTN: SALES TAX, 11465 W. CIVIC CENTER DRIVE, #270, AVONDALE, AZ 85323
(623) 333-2001 FAX (623) 333-0200
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