Privilege (Sales) And Use Tax Application Form - Tempe Tax And License Division
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1
2
3Privilege (Sales) and Use Tax Application
New Business
Former Owner (if applicable)
Previous City License #
Check any
License #
New Owner of Existing Business
that apply:
Name Change Only
Current City License #
Date of Change
Location Change
FEES
SECTION I. BUSINESS INFORMATION
Application Fee
Business Name (Individual, Company or "DBA", first name first)
$20.00
License Fee
Street No.
(N,E,S,W)
Street Name
Type
Ste/Apt #
(See Back)
-
(Circle One)
City
State
Area Code
Business Telephone #
ZIP Code
Start Date
E-mail address
-
$50 $25 $10
State License #
Federal ID #
Total Fees
SECTION II. MAILING ADDRESS & PHONE NUMBER
(Circle One)
(
)
$70 $45 $30
Enter Name if Different from Section I (above) or Enter 'In-Care-Of' Name
Telephone #
For Office Use
Street No.
(N,E,S,W)
Street Name
Type
Ste/Apt #
Only
(
)
-
Status Code
City
State
Fax #
ZIP Code + 4
SECTION III. BUSINESS OWNERSHIP & RECORD LOCATION
Individual
LLC
Corp. - State Inc.______
Gen. Partnership
Ltd. Partnership
Other _____________
1)
Name
Social Security #
Owners, Partners,
SIC Codes
LLC Members, or
Home Address
Title
Officers
(For Additional Names,
Please Attach List)
City
State
ZIP Code
Phone No.
(
)
2)
Name
Social Security #
Geo Code
Home Address
Title
City
State
ZIP Code
Phone No.
(
)
Name
Phone No.
Corporate or LLC
(
)
Statutory Agent
Name
Phone No.
Location Where
(
)
Business Records
Address
City
State
ZIP Code
Are Kept
SECTION IV. BUSINESS TYPE
Retail Sales
Wholesaler
Amusement
Construction Contracting
Use Tax
Restaurant/Bar
Manufacturer
Commercial Rental
Residential Rental (# of Units ______ )
Hotel/Motel
Other_____________________________
Describe Nature of
Contractors #
Business
# of Employees
Check method you will use in submitting reports:
Cash Receipts
Accrual
SECTION V. BUSINESS PREMISES STATUS
Check one:
Do you own your business location?
Yes
No
If yes, Is this your residence?
Yes
No
If no, complete the following Landlord/Property Manager information
Landlord/Property Manager Name
Address
Phone #
(
)
Do you rent a portion of the business premises to another entity?
Yes
No
I certify that the statements made in this application are true and complete to the best of my knowledge. I accept the license authorized and issued in
response to this application with the condition that I report timely and pay any and all taxes due by me to the city. Incomplete forms may not be processed.
IF APPLICABLE, BE SURE ALL SALES TAX HAS BEEN PAID BY FORMER OWNER. BY LAW YOU MAY BE LIABLE FOR ANY UNPAID TAX.
Print Name
Signature
Title
Date
License App. Rev. 9/2001
CLEAR FORM
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