Business And Tax License For Private Security Service Application Form - City Of Evans, Colorado Page 2

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Business and Tax License for Private Security Service Application (continued)

SECTION TWO – All information provided in this section of the application is considered confidential.

□

17. Tax Filing frequency: $300 tax/month or more, file monthly

Under $300 tax/month, file quarterly

$300 tax/year or less, file annually

18. List Owner(s) or Corporate Officers (attach additional sheet if necessary)

__________________________________________________________________________________________(________)___________-_________________

Name

D.O.B.

Position

Home Phone

_________________________________________________________________________________________________________________________________

Home Address

City

State

Zip Code

__________________________________________________________________________________________(________)___________-_________________

Name

D.O.B.

Position

Home Phone

_________________________________________________________________________________________________________________________________

Home Address

City

State

Zip Code

19. List cities in which your company currently/previously business:

_________________________________________________________________________________________________________________________________

City

State

Dates

_________________________________________________________________________________________________________________________________

City

State

Dates

_________________________________________________________________________________________________________________________________

City

State

Dates

20. Accountant or CPA or Local Manager: _________________________________________________________________________________________________

(Person who can provide sales tax information if needed)

___________________________________________________________________________________________(_______)__________-__________________

Address

City

State

Zip

Daytime Phone

21. Former Owner’s Name (if applicable): ____________________________________________ Former Owner’s License Number: _________________________

22. Former Name of Business: _____________________________________________________ Date of Purchase: __________/___________/_________________

□

23. Did the purchase price include fixed assets, machinery, or equipment? Yes

Value $ _________________________

24. State of Colorado Tax License Number: ___________________________________________ Federal Employer ID (FEIN): _____________________________

SECTION THREE – Please complete the following:

25. Has any officer, director, or partner of the company ever been convicted of a felony, misdemeanor, or ordinance violation involving moral turpitude within the

past ten (10) years, excluding traffic violations? ____________

If yes, explain: ____________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________

26. Has any officer, director, or partner of the company ever had a judgment or conviction for fraud, deceit, or misrepresentation entered against them within the past

ten (10) years? ____________

If yes, explain: ____________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________

27. Describe the nature and type of business to be conducted or services to be offered and the area expected to be covered. __________________________________

_________________________________________________________________________________________________________________________________

28. Number of vehicles: ______________________ Describe vehicles used (year, make, color, license plate number, etc.) __________________________________

_________________________________________________________________________________________________________________________________

29. Describe uniforms used (color, badges, insignia, etc.): _____________________________________________________________________________________

_________________________________________________________________________________________________________________________________

30. Describe any other equipment to be used in the conduct of business. __________________________________________________________________________

_________________________________________________________________________________________________________________________________

**PLEASE COMPLETE ALL SIDES OF APPLICATION**