Form St: Ua - Application For A Utility Tax License
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ST: UA
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LABAMA
EPARTMENT OF
EVENUE
OFFICE USE ONLY
S
, U
& B
T
D
ALES
SE
USINESS
AX
IVISION
Aggregate Chain Number
P. O. Box 327710, Montgomery, AL 36132-7710
Application For A Utility Tax License
Account Number
(Required by Section 40-21-84, Code of Alabama 1975)
Please complete each line applicable to your business.
Your license will not be issued until your application is completed properly.
1. Federal Employer Identification Number (FEIN)
2. Name of Person(s), Firm, Corporation, Association, or Co-Partnership Making Application
3. Doing Business As
4. Mailing Address of Home Office (P.O. Box, Street and Number, or R.F.D.)
City
County
State
Zip Code
5. Number of Businesses Operated in Alabama
6. Location — City
Street or Highway
County
Location must be an exact street number or, if located on a highway or rural route, give details as to location. If more than one loca-
tion, use the schedule on the back of this application to list the other locations.
7. Check The Type of Utility Sold / Purchased
Domestic Water
Natural Gas
Electricity
Telephone Services
Telegraph Services
8. Check Appropriate Box
Sole Proprietorship
Partnership
Corporation
Multi Member LLC
Single Member LLC
Limited Liability Partnership
Other _____________________________________________________
If applicant is a corporation, a copy of the certified certificate of incorporation, amended certificate of incorporation, certificate of
authority, or articles of incorporation should be attached. If applicant is a limited liability company or a limited liability partnership, a
copy of the certified articles of organization should be attached.
9. Ownership Information
Corporations — Give name, title, home address, and Social Security Number of each officer.
Partnerships — Give name, title, home address, and Social Security Number or FEIN of each partner.
Sole Proprietorships — Give name, title, home address, and Social Security Number of Owner.
Limited Liability Companies — Give name, title, home address, and Social Security Number or FEIN of each member.
Limited Liability Partnerships — Give name, title, home address, and Social Security Number or FEIN of each partner.
10. Name of Former Owner of Business
11. Date Business Is To Begin Operation
12. Business Telephone Number
13. Home Telephone Number
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)
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)
This application requires the signature(s) and title of the sole proprietor, each partner, an elected corporate officer, or a member.
Signature_____________________________________________
Signature ____________________________________________
Title _______________________________ Date _____________
Title _______________________________ Date _____________
Mail Original and One Copy of Application To The Address Above.
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