Application For New Business Tax License Form
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1DAVIDSON COUNTY CLERK’S OFFICE
Date __________________
JOHN ARRIOLA, COUNTY CLERK
Receipt # ______________
Business # _____________
Application for New Business Tax License
and report to the County Clerk
(as required by T.C.A. 67-4-706)
Exact Business Name and Location:
Business Mailing Address:
_____________________________________________________
_____________________________________________________
Name (give advertised business name)
Name (enter corporate name if applicable)
_____________________________________________________
_____________________________________________________
Street and Highway (Do not use PO Box)
Street, Highway or PO Box Number
_____________________________________________________
_____________________________________________________
City
State
Zip
City
State
Zip
_____________________________________________________
_____________________________________________________
Business Phone Number
Home Office Area Code and Phone Number
Business Information
Type of Ownership:
❑ Proprietorship
❑ Partnership
❑ Federal Employer Identification: _______________________________________
❑ LLC
❑ Corporation
❑ Name of Corporation: _______________________________________________
Is the business:
❑ Retail
❑ Wholesale
❑ Both
❑ Contractor
❑ Service
Contact Email Address _________________________________________________
Dominant Product Sold or Service Performed: ____________________________________________________________________________________________
Sales Tax Number: ________________________________________ Date Business Opens: _______________________________
Reason for filing this application:
❑ New Business
❑ Change in corporate structure
❑ Purchase of existing business
Old business name was _________________________________________________
Ownership Information
Identify owners, officers and/or partners (attached extra sheet if necessary)
_____________________________________________________
_______________________________
_______________________________
(1) Name
Title
Home Phone
Social Security Number
_____________________________________________________
_______________________________
_______________________________
Street Address
City
State
Zip
_____________________________________________________
_______________________________
_______________________________
(2) Name
Title
Home Phone
Social Security Number
_____________________________________________________
_______________________________
_______________________________
Street Address
City
State
Zip
Business District
My business resides in the:
Please check one of the following:
__________County(GSD) only – Minimum tax $15.00, Recording fee $7.00, total payment due $22.00 (Please pay this amount)
__________City(USD) and County(GSD) – Minimum tax $30.00, Recording fee $12.00, total payment due $42.00 (Please pay this amount)
Effective July 1, 2008, Tennessee Code Annotated 8-21-701 increased the business tax recording fee from $5.00 to $7.00 per return for the County.
Signatures
Signature of Owners or Corporate Officer (ALL OWNERS must sign and include photocopy of driver’s license.)
____________________________________________
____________________________________________
____________________________________________
____________________________________________
Make remittance check payable to “Davidson County Clerk”
MAIL TO:
Davidson County Clerk
523 Mainstream Drive
P.O. Box 196333
Please call (615) 862-6254 with questions
Nashville, TN 37219-6333
This application must be received within 20 days from commencement of business or penalty and interest will apply.
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Parent category: Business