Applicaion Business Registration Certificate Partnership Or Corporation - California Treasurer/tax Collector
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1
2Office of the Treasurer/Tax Collector
Certificate No:___________________
José Cisneros, Treasurer
Registration Fee:_____________________________
George Putris, Tax Administrator
Initials & Date:______________________________
BUSINESS TAX/TAXPAYER ASSISTANCE
City Hall, Room 140
1 Dr. Carlton B. Goodlett Place, SF, CA 94102-0917
Tel: (415) 554-4400; Fax: (415) 554-6207; TTY (415) 554-4455
A P P L I C A T I O N
BUSINESS REGISTRATION CERTIFICATE
PARTNERSHIP or CORPORATION
Please Print or Type
PARTNERSHIP or
BUSINESS STRUCTURE:
LIMITED LIABILITY
CORPORATION
OTHER: _____________________________________________
)
(
(check box
Give Description)
OWNERSHIP
NAME:______________________________________________________________________________________________________________
Partners' Names (Last, First, Middle Initial)
or
CORPORATE NAME
( 30 Characters Maximum )
_____________________________________________________
___________________________________________________________
FEIN # (Provide proof of number issued by IRS)
STATE CORPORATE NUMBER (If applicable)
_____________________________ OWNERSHIP TYPE:
Trust
Estate
Associate
Joint Venture
Public
Private
Other
S.F. Starting Date
(Check One)
MAILING ADDRESS:
Complete Part A, if the accounting record location is different from the mailing address.
)
Complete Part B, if the business location is different from the mailing address.
(Complete all information
AND
_________________________________ _______________________________ ___________ ____________________________________
Last Name
First Name
Middle Initial
Title/Position
__________________________________________________________________________
(
_ )______________________________________________
Street Address
Area Code
Telephone
_____________________________________
___________________________________
___________
________________________________________
City
State
Zip Code
Country (Foreign Address)
PART A: ACCOUNTING RECORD LOCATION
______________________________________
__________________________________
____________
_______________________________________
Last Name
First Name
Middle Initial
Title/Position
___________________________________________________________________________
(________)_____________________________________________
Street Address
Area Code
Telephone
______________________________________
__________________________________
___________
________________________________________
City
State
Zip Code
Country (Foreign Address)
PART B: BUSINESS LOCATION
____________ _________________________________ __________ _____________________________ ___________
(
)____________________
Street No.
Street Name (P.O.Box Not Acceptable) Suite/Room
City/State
Zip Code
Area Code
Telephone
BUSINESS NAME (DBA):__________________________________________________________________________________________________
( 30 Characters Maximum )
BUSINESS DESCRIPTION:
______________________________________
$______________________ $_____________________ ____________ ________ ________
Description of Business
Est. Gross Receipts (12 mos)
Est. Payroll (12 mos)
# of Employees Bus. Class
PBC
(prior to tax year 2000)
______________________________________
$______________________ $_____________________
____________ ________ _______
Description of Business
Est. Gross Receipts (12 mos)
Est. Payroll (12 mos)
# of Employees
Bus. Class
PBC
(prior to tax year 2000)
FOR APARTMENT BUILDING OWNER/OPERATOR:
Number of Apt. Units_______________
Number of Commercial Units_______________
APPLICATION CONTINUES ON THE REVERSE SIDE
Applicatio1 02/07/2005
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