Form St-Crts - Application For A Mobile Communication Services Tax License
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1
2A
D
R
ST: CRTS
1/02
LABAMA
EPARTMENT OF
EVENUE
OFFICE USE ONLY
S
, U
& B
T
D
ALES
SE
USINESS
AX
IVISION
AGGREGATE CHAIN NO.
P. O. Box 327710, Montgomery, AL 36132-7710
ACCOUNT NO.
Application For A
Mobile Communication Services Tax License
PLEASE COMPLETE EACH LINE APPLICABLE TO YOUR BUSINESS.
YOUR LICENSE WILL NOT BE ISSUED UNTIL APPLICATION IS PROPERLY COMPLETED.
1. Federal Employer Identification Number (FEIN) __________________________________________________________________
2. ________________________________________________________________________________________________________
Name of Person(s), Firm, Corporation, Association, Co-Partnership Making Application.
________________________________________________________________________________________________________
Doing Business As.
3. Mailing Address of Home Office ______________________________________________________________________________
P.O. Box, Street and Number, or R.F.D.
________________________________________________________________________________________________________
City
County
State
Zip Code
4. Number of Businesses in Alabama __________.
Location _________________________________________________________________________________________________
City
Street and Number or Hwy.
County
Location must be exact street number or, if on a highway or rural route, give details as to location. If you have more than one
location, use schedule on back to list locations.
5. 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.
6. 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.
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
7. Type of Services Provided:
Commercial Mobile Radio
Paging/Beeper
Other ___________________________
Identify
8. Name of Former Owner of Business ___________________________________________________________________________
9. Date Business Is to Begin Operation ___________________________________________________________________________
10. Business Telephone Number (________)___________________ Home Telephone Number (________)___________________
(This application requires the signature(s) and title of the sole proprietor, each partner, an elected corporate officer, or a member.)
Signed ______________________________________________
Signed ______________________________________________
Title _______________________________ Date _____________
Title _______________________________ Date _____________
MAIL ORIGINAL AND ONE COPY OF APPLICATION TO THE ADDRESS ABOVE.
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Parent category: Financial