Application For License/tax Information - City Of Tuscaloosa
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1OFFICE USE ONLY:
CITY OF TUSCALOOSA
Account ID # _________
Issued # ________
APPLICATION FOR LICENSE/TAX INFORMATION
Issued By:
_________
Issue Date: ________
Code Compliance Certificate # ________
(205)248-5200 FAX (205)349-0180
CHECK THE LICENSE/TAXES FOR WHICH YOU ARE LIABLE
:
Business License
Rental Tangible
Use Tax
Renting/Leasing Commercial Property
Personal Property Tax
Sales Tax
Tobacco
Renting Residential Property
Lodging Tax
Wine Tax
BUSINESS NAME:
CORPORATE ADDRESS:
CORPORATE NAME OR INDIVIDUAL OWNER NAME:
BUSINESS LOCATION:
MAIL ADDRESS FOR TAX FORMS:
MAIL ADDRESS FOR LICENSE RENEWALS:
BUSINESS PHONE:
CELL PHONE:
CONTACT NAME:
CONTACT PHONE:
FAX:
HOME PHONE:
PRINCIPAL BUSINESS ACTIVITY AND PRODUCT:
OWNER NAME(S):
STATE LICENSING BOARD #
FEDERAL ID TAX #
DOB:
STATE OF ALA SALES TAX #
DRIVERS LICENSE #
ST OF ALA SELLERS USE TAX #
SS#
ST OF ALA CONSUMERS USE #
TYPE OF BUSINESS:
FORM OF ORGANIZATION:
MANUFACTURER
CONTRACTOR
CORPORATION
PARTNERSHIP
WHOLESALER
RETAILER
INDIVIDUAL OWNER
LLC
OTHER
OTHER:
OFFICERS, PARTNERS, OR OWNER: (USE BACK OF FORM IF MORE SPACE IS NEEDED)
NAME:
TITLE:
HAS ANY OWNER OF THIS BUSINESS BEEN CONVICTED OF A FELONY IN THE LAST FIVE YEARS? Y or N
IF YES,
PLEASE EXPLAIN: _________________________________________________________________________________________
__________________________________________________________________________________________________________
ESTIMATED GROSS RECEIPTS THRU END OF YEAR:
$ ______________________________ CITY
$ ______________________________ PJ
$ ______________________________ OUT
I HEREBY CERTIFY THAT ALL INFORMATION AND STATEMENTS HEREIN ARE TRUE AND CORRECT:
SIGNATURE:
PRINTED NAME:
TITLE:
PHONE:
DATE:
COMPLETE AND RETURN THIS FORM TO:
City of Tuscaloosa Revenue Department
P O Box 2089, Tuscaloosa, AL 35403
(205) 248-5200 Fax:(205) 349-0180
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