Business Registration Form - City Of Henderson printable pdf download

City of Henderson

Business Registration Form

240 Water Street

Henderson NV

89015

702-267-1730

Reinstatement

Office

- Must meet

eligibility requirements

Use Only:

New Business

Change in:

Location

Name

Other -

Opening Date:

Applicant/Owner:

Received:

Doing Business As/Operating Name:

*Prior Business Name/Owner/Address:

Business Phone:

Business Fax:

Business Address:

Mailing Address:

Street:

City, State, Zip:

Type Of Business:

Sole Proprietor

LLC

Corporation

General Partnership

Other_________________

**Name of Owner(s), Partners, Officers:

**Officers listed on this application are only to be the titles/roles filed with the Nevada Secretary of State**

Name:

Title:

Name:

Title:

Name:

Title:

Business Description: Concisely describe the type of business activity/activities to be conducted in or from the City of Henderson:

Declaration - i.e. Amount of anticipated gross revenues for first 5 months, or number of State

licensed professionals operating at this location, or number of vehicles, etc.

**Fixed fee license types do not have a declaration.**

**Refer to your checklist and/or Business Licensing for your declaration type**

Office Use

Only:

Certification:

(I) (We), the undersigned have answered all questions in the above application, and to the best of my (our) belief all answers are true and correct. (I)

(We) further understand that disclosure of any false or misleading or any incomplete answers in the above could result in automatic denial, or

revocation, of the license if already issued:

In addition, (I) (We) acknowledge and understand the following:

1. (I) (We) cannot commence operation until Business License Division requirements approval is received from the Business License Division.

2. (I) (We) must notify the Business License Division of any change including business name, addresses, ownership, corporate officers, management

or key employee, where applicable.

3. (I) (We) may not operate the business for which this application is made at any other address than that listed on this application.

4. (I) (We) are solely responsible for maintaining current and active licenses applicable to the operation of our business, including the payment of

fees in accordance with the appropriate licensing categories.

5. (I) (We) may be subject to issuance of a misdemeanor citation for each and every day (I) (We) are in violation of any of the above. Should this

application be granted, (I) (We) accept same subject terms and provisions thereof and subject to such rules and regulations as may at any time be

adopted or enacted by the City Council of the City of Henderson, Nevada; and specifically agree to observe and keep inviolate all of the provisions of

such ordinances.

Signature of Applicant:

Date:

Business Registration Form - City Of Henderson

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