Application For Occupational/business License Form - Bellevue, Kentucky
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1
2The City of
616 Poplar Street
Bellevue, Kentucky 41073
BELLEVUE, KENTUCKY
Phone: 859-431-8888
Fax: 859-261-8387
APPLICATION FOR OCCUPATIONAL/BUSINESS LICENSE
WARNING:
Statements in this application shall be made under oath, or by affirmation or by any other legally authorized manner of attesting to
the truth of such statement. Any false statements made herein shall be punishable according to law; and may be cause for denial of the application
or the revocation of the business license issued pursuant to City of Bellevue Ordinance 2007-12-01.
Complete Name of Business____________________________________________________________________________________
Address:
____________________________________________________________________________________
City, State and Zip + 4:
____________________________________________________________________________________
Telephone: ________________________ Fax: _______________________ Emergency or Night no. _______________________
E-Mail Address: ____________________________________________________________________________________________
Street address of where business will be conducted: _________________________________________________________________
Mailing Address for Tax Forms (if different from above): ____________________________________________________________
City, State and Zip + 4: _______________________________________________________________________________________
Contact Persons: For Payroll Withholding, Annual License Fees, Business License Renewal Fee:
Name: _________________________________________________ Title _____________________ Telephone _______________
For electrical, plumbing or HVAC contractors: State License Number: _________________________________________________
CHECK ONE ONLY AND COMPLETE:
List All Hazardous Materials, Pets or Guard Animals, Used or Located
______________________________________
on Property
Sole Proprietor: S.S. No. _______-_________-________
Date of Birth _______/_________/________
Month
Day
Year
Will any part of business activity be performed from your home?
___Yes
___No
Corporation: (Date Organized) _____/____/____State___
Accounting Period: Calendar Year Fiscal Year Ending _____/____
_____/______/________
Date Business to Begin
Month Day
Month
Day
Year
Process Agent Name ________________________________________
Address
________________________________________
Do you or will you have employees? ____Yes ____No
City, State, Zip
________________________________________
______Est. No. of employees
Officers’ Names
________________________________________
And Addresses
________________________________________
Do you or will you use Independent Contractors? ____Yes ___No
________________________________________
(if yes include names & addresses)
PARTNERSHIP:
_________________________________________
Do you or will you use “Leased” or “Temporary Help” employees?
Partners’ Names
_________________________________________
____Yes ____No ___Est. No. of employees
And Addresses
________________________________________
(if yes, include name(s) and address(es) of leasing or temporary
_________________________________________
agency(s).
_________________________________________
_________________________________________________________
NON-PROFIT (Attach IRS Determination of Status)
_______________________________________________________
OTHER:
_________________________________
________________________________________________________
Please Describe _________________________________
Nature of Business (Please describe your business and its operation,
including where and how sales, services or other activities take place)
____-____________
FEDERAL TAX IDENIFICATION NUMBER:
_________________________________________________________
I HEREBY CERTIFY THAT ALL INFORMATION AND STATEMENTS HEREIN ARE TRUE AND CORRECT. (Application and
payment will be returned if any part incomplete). Occupational License will be issued upon processing of completed application.
X______________________________________________________________________________________________________________________
(SIGNATURE)
(DATE)
(PRINT NAME)
(PHONE NO.)
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