Std License Form V1 - Business Application - 2006
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1
2Std License Form v1 Nov 2006
CITY OF HELENA , ALABAMA BUSINESS APPLICATION
The City Does Impose the Business License Tax in its Police Jurisdiction
(CONFIDENTIAL)
Applicant Complete This Box
Complete and Mail/Fax To:
FEIN
___________________
ST of ALA TAX # ___________________
CITY OF HELENA
FORM OF OWNERSHIP (Check One)
PO BOX 613
HELENA, AL 35080-0613
Sole Prop. _____
Partnership ______
Corp. _____
Prof Assoc ______
(205) 663-2161
Fax (205) 663-9276
LLC ______
Other ___________
Please Print or Type
SEE REVERSE SIDE FOR INSTRUCTIONS AND FURTHER INFORMATION
Application Type :
New ____
Owner Change ____
Name Change _____
Location Change _____
Legal Business Name :
___________________________________________________________________________________________
Trade Name: (If different from above) _________________________________________________________________________________
Business Activities:(Brief description- Retail clothing sales, wholesale food sales, rental of industrial equip., computer consulting, etc)
________________________________________________________________________________________________________________
Physical Address:
___________________________________________________________________________________________
(Street)
(City)
(State)
(Zip)
Mailing Address:
(Street)
(City)
(State)
(Zip)
Telephone:
___________________________________________________________________________________________
(Business)
(Fax)
(Home Phone)
Name & Phone # for Contact Person __________________________________________________(____)__________________________
Email address for contact:
___________________________________________________
List Following for Owner(s), Partners, or Officers (Attach separate sheet if necessary)
Name
Residence Address
SSN (if not publicly traded co.)
Title
Date Business Activity Initiated or Proposed in Helena:___________________ # of Employees in Helena _________________
This application has been examined by me and is, to the best of my knowledge, a true and complete representation of the above named entity, and person(s)
listed.
Date ____________________
Signature ___________________________________________________Title _________________________________
THIS AREA FOR MUNICIPAL USE ONLY
ACCOUNT ID # __________________ LICENSE CODE _______________________ AMOUNT $_________________
REVIEWED BY: ___________________
PHYSICAL LOCATION
CITY
POLICE JURISDICTION
OUTSIDE CORP LIMITS & PJ
:
ZONING CLASSIFICATION: ______________ BUILDING APPROVAL:
YES
NO
N/A
FIRE CODE
Tax Types:
Sales/Seller’s Use
Consumer Use
Rental/Lease
Alcohol
Tobacco
Gas/Motor Fuel
Business License
Tax Filing Frequency:
Monthly
Quarterly
Annual
Occasional
Business Type:
Retail
Wholesale
Building Contractor
Service
Professional
Manufacturer
Rental
Other _________________________
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Parent category: Business