Application For Portland Business License Form

SOME OF THE INFORMATION PROVIDED ON THIS FORM MAY BE SUBJECT TO DISCLOSURE UNDER PUBLIC RECORD LAW

20) If any of the current owners of this business have a current or expired PORTLAND license, give account information:

NAME:

ACCOUNT#:

Year licensed:

21) OWNERS OF CORPORATION OR PARTNERS (List Corporate Owners that hold more than 5% of the voting stock of the

corporation – List all partners, including limited partners, if any) and all LLC members. Use additional sheets if necessary.

NAME

ADDRESS, CITY, STATE, ZIP CODE

STOCK

Check one

# of

22) ADDRESSES OF RENTAL PROPERTY OWNED: Use additional sheet(s) if necessary.

COMMERCIAL

units

RESIDENTIAL

23) If the business address is on LEASED or RENTED COMMERCIAL PROPERTY, list the name and address of the property

owner below:

PROPERTY OWNER NAME

ADDRESS, CITY, STATE, ZIP CODE

The term "license" as used in the ordinance is not to be construed to mean permit. The Business License fee is for revenue

purposes, and is not a regulatory permit fee. The payment of a license fee and the acceptance of such a fee and issuance

of a license by the City does not entitle a licensee to carry on a business not in compliance with all applicable requirements

of state, federal, municipal or other law. The undersigned declares under penalty of making a false certificate that the

information given in this report is true.

Signature of Licensee or Authorized Representative

Title

Date

A Business License is required of all those doing business within the City of Portland, Oregon. Exemptions include

non-profit agencies and businesses whose total gross receipts for all business everywhere is less than $25,000

annually. License fees are based upon net income; the minimum annual fee is $100.

When obtaining the original license, complete this application and return it with $100.00. You will receive a license which expires at the

end of the current business year. In the first month of your next business year, you will receive a postcard reminder to renew and you will

have until the 15

day of the fourth month after your expiration date to renew your license without penalty. The renewal fee will be

determined by the income figures filed on the renewal form. The initial $100 payment is a minimum fee which may be adjusted upward

after your actual income figures are known.

Notice of Confidentiality: All tax returns, reports and related financial information, including a Taxpayer ID number, filed

with the City of Portland are confidential. Except as provided by PCC 7.02.230, .240 and .250, it is unlawful to divulge

or release any financial information submitted or disclosed to the City.

Revised 01/03

Application For Portland Business License Form - 2003 Page 2