Application For Business Tax Registration Certificate Form - State Of California

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APPLICATION for

CITY OF LOS ANGELES

OFFICE OF FINANCE

200 NORTH SPRING ST. RM 101

BUSINESS TAX REGISTRATION CERTIFICATE

LOS ANGELES, CA 90012

PLEASE NOTE that if you are involved with any type of SALES ACTIVITIES, either RETAIL or WHOLESALE, you are REQUIRED to also

fill out the Tobacco Retailer's Questionnaire / Application.

Current Date

The following information is subject to disclosure

Business Type:

Indiv

Partnership

Corp

LLC

Trust

Please print or type

Legal Name:

Do not use DBA (fictitious name) here

Business Address:

Do not use P.O. Box here

Street Adress

City

State

Zip Code

Commercial

Residence

Business Start Date (MM/DD/YYYY):

Location Type:

Business Name (DBA):

Care Of (c/o):

Mailing Address:

If different from Business Address

Street Address or P.O. Box

City

State

Zip Code

Commercial

Residence

Business Phone Number:

Location Type:

Description of Business:

Primary Business / Professional Activity Code:

Secondary Activity Code:

Social Security No. (SSN) -OR- Federal Employer Identification No. (FEIN):

Sales Tax Number (Seller's Permit):

Gross Receipts:

(if your business began prior to the current year, please complete the gross receipts information below)

Calendar Year 2004

Calendar Year 2005

Calendar Year 2006

Business Activity / Date Activity Started

Gross Receipts

Please note: A minimum business tax may be due based on your business activity(ies) for the first year of operation.

Contact Person:

Title:

Contact Phone Number:

Email Address:

I declare, under penalty of perjury under the laws of the State of California, that to the best of my knowledge, the foregoing is true, correct

and complete.

Signature of Owner or Agent:

Date:

Daytime Phone Number:

Print name of Owner or Agent:

1 This is the 6-digit Primary / Principal Business or Professions Activity Code reported on your Federal Tax Return. A Secondary business activity is one that

comprises at least $1,000,000 and 40% of your gross receipts. Go to for an NAICS code listing.

2 If your business is located within the City of Los Angeles and a portion of your gross revenue is derived from outside the City, or your business is located outside the City

and a portion of your gross revenue is derived from inside the City, then applicable apportionment formulas may reduce your tax liability.

3 Due to the large number of various business activities described under LAMC Section 21.43 to 21.197, it is not practical to list each separately. For specific activities and

rates, contact the Office of Finance or visit our website @

4 By completing this form and submitting it to the Office of Finance in an electronic format, such as email, you agree that the sumbitted form has the same legal effect,

validity and enforceability of a form submitted to us via US mail or in person. You also agree that the aforementioned form legally represents a document sent by you or

your legal representative.

As a covered entity under Title II of the Americans with Disabilities Act, the City of Los Angeles does not discriminate on the basis of disability and, upon request, will provide reasonable accommodations to ensure equal

REV 3/2007

access to its programs, services, and activities.