Business Application Form - City Of Robertsdale, Alabama
ADVERTISEMENT
1BUSINESS APPLICATION
CITY OF ROBERTSDALE, ALABAMA
(Confidential)
Print or Type this Form
↓↓ ALABAMA’S IMMIGRATION LAW REQUIRES ↓↓
*Verification of Lawful Presence in US*
Type of Document used to Verify Immigration Status:
for all businesses owned by individuals or general partnerships
* ATTACH LEGIBLE COPY OF VERIFICATION TO APPLICATION *
__________________________________________________
Valid Driver’s License or Non-driver ID
State Issued: ___________
#____________________
Expiration Date: __________________
MAIL TO:
Federal Employee ID #_____________________
Important: Driver’s license or non-driver ID card not issued by
City of Robertsdale, Revenue Department
Alabama must indicate on the card that holder has provided
Alabama Dept of Revenue _________________
satisfactory proof of US Citizenship. Must be unexpired to be valid.
P.O. Box 429
Alabama Regulatory License #_______________
Other Acceptable Documents
: US Passport; Permanent Resident Card or
Robertsdale, AL 36567-0429
Alien Registration Receipt Card (Form I-551); Foreign passport that
contains a temporary I-551 stamp or printed notation on a machine-
Form of Ownership (Check One)
Contact Numbers: Office (251) 947-8920
readable immigrant visa; foreign passport with Form I-94 or I-94A;
Sole Proprietor
General Partnership
Employment
Authorization
Document that contains a photograph
FAX (251) 947-1129 TDD (251) 947-2122
(Form I-766); birth certificate that verifies US citizenship; US naturalization
Corporation
Professional Association
e-mail:
documents;
Bureau of Indian Affairs card or American Indian card;
LLC
Other _______________
Certificate of Citizenship issued by the US Citizenship and Immigration
Website:
Services.
APPLICATION DATE: ______________
TYPE:
NEW
RENEWAL
OWNER CHANGE
NAME CHANGE
LOCATION CHANGE
TAX TYPES:
BUSINESS LICENSE
TOBACCO
GAS/MOTOR FUEL
ALCOHOL (beer, wine, liquor)__________________
SALES
SELLER’S USE
CONSUMER USE
RENTAL
LODGING
Legal Business Name: _________________________
________________________________________________________________
Doing Business As (if different from above): _________________________________________________________________
Business Activity & Product:
(Write a brief description - example. retail clothing sales, wholesale food sales, rental of industrial equip., computer consulting, etc)
________________________________________________________________________________________________________________
_______________________________________________________________________________________
If you make deliveries or sales into the city limits or PJ, indicate how you make the sale and how the product is delivered:
Sales Method: _______________________________________
Delivery Method: _____________________________________________
PHYSICAL LOCATION:
CITY LIMITS
POLICE JURISDICTION (PJ)
OUTSIDE CTIY LIMITS & PJ
Physical Address: __________________________________________________________________________________________________
(Street)
(City)
(State)
(Zip)
Mailing Address: __________________________________________________________________________________________________
(Street)
(City)
(State)
(Zip)
Telephone: _______________________________________________________________________________________________________
(Business)
(Fax)
(Home Phone – In Case Of Emergency)
e-mail address:
Name/Phone Number for Contact Person:
__________________________________________________ (
)___________________
List Names of Owner(s), Partners, or Officers (Attach separate sheet if necessary)
Name
Residence Address
SSN
Title
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Are hazardous materials used at this location? Yes __ or No __
Coin-Operated Vending Machines at this location? Yes__ or No__
Date business activity initiated or proposed to be initiated in ROBERTSDALE: ____________
Annual anticipated Gross Receipts or Gross Receipts for the preceding year: $ _____________
This application has been examined by me and is, to the best of my knowledge, a true and complete representation of the above named entity,
and person(s) listed and I am authorized to sign legal documents. I attest, under penalty of perjury, that I am (check 1 of the following 4
selections ): (1)___A citizen of the United States; (2)___A noncitizen national of the United States (born in American Samoa, certain former
citizens of the former Trust Territory of the Pacific Islands, and certain children of noncitizen nationals born abroad; (3)___ A lawful
permanent resident (Alien #______________); or (4)___ An alien authorized to work (Alien # or Admission #_____________ until
____________(expiration date).
Date __________________ Signature ______________________________________________
Title __________________________
(Applicant/Partner/Member/Officer/Power of Attorney Representative)
Business Application COR Revised 10-2011
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial