Multnomah County Business Income Tax Taxfilers Form

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City of Portland Oregon
OFFICE USE ONLY
Bureau of Licenses
th
1900 SW 4
Ave RM 3500
ACCOUNT #
Portland OR 97201-5350
Office: (503) 823-5157
FAX: (503) 823-5192
MULTNOMAH COUNTY BUSINESS INCOME TAX TAXFILERS FORM
1)
NAME:
PRINT Name(s) of Owners, Partners, Corporation – as filed on the State of Oregon Tax Return
OWNERS
ALL PARTNERS
OWNERS: PLEASE LIST
OF CORPORATIONS (OWN 5% STOCK) &
ON THE BACK OF THIS FORM.
2)
BUSINESS NAME/Doing Business As (DBA):
[If different from above NAME]
3)
BUSINESS CONTACT NAME:
CONTACT TITLE:
CONTACT PHONE:
(
)
Is this person authorized to represent the licensee?
Yes
No
4)
TAX ENTITY:
Sole Proprietor
Partnership
Corporation
Estate
Trust
Ltd. Liability Co.
Ltd. Partnership
S – Corporation
Other:
(check one)
5)
FISCAL YEAR
BUSINESS FAX:
6)
TAX ENTITY ID #
END:
(
)
F.E.I.N:
SS #:
7)
NUMBER OF
8)
DATE BUSINESS ACTIVITY
?
9)
Is there business activity outside Mult Co.
Yes
No
OWNERS:
BEGAN IN MULTNOMAH
IF YES, describe business activity outside Mult Co.:
COUNTY:
10)
BUSINESS ADDRESS: (location)
(Use back of form to list additional locations)
Number/Street - NOT PO BOX
City, State, Zip Code
11)
BUSINESS PHONE:
12)
PROPERTY TYPE: Is business address on:
(
)
COMMERCIAL
RESIDENTIAL property?
13) BUSINESS ACTIVITY DESCRIPTION:
(
Office Use Only)
SIC CODE:
If business activity includes rental/leasing residential or commercial property, list property addresses on back of this
form
14) MAILING ADDRESS:
(If different from line 10 above)
?
15) Is this a new business
Yes
No
If no, give name of previous owner:
If yes, give business license number:
16) Does this business have any business activity within the Portland city limits? (Business activity includes sales, service,
manufacturing and property rental.)
Yes
No
17) If the business address is on LEASED, OR RENTED COMMERCIAL PROPERTY, give name and address of property owner:
NOTICE OF CONFIDENTIALITY: All tax returns, reports and related financial material filed with Multnomah County
and/or the City of Portland are confidential. Except as provided by MCC sections 5.60.230, 240 & 250, it is unlawful to
divulge or release any financial information submitted or disclosed to the County or City.
COMPLETE BOTH SIDES OF APPLICATION – SIGNATURE REQUIRED ON REVERSE
Revised 11/98

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