Application For Sales And Use Tax License

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Finance Dept _________________
APPLICATION FOR SALES AND USE TAX LICENSE
NO FEE REQUIRED
Owner’s or Corporate Name
Name of Business (DBA)
Business Address (Street, City, State, Zip)
Mailing Address (Street, City, State, Zip)
Nature of Business (Type of sales/service)
Does your business acquire, possess, cultivate, manufacture, produce, use, sell, distribute, dispense, or transport medical
marijuana?
 Yes
 No
Ownership
 Individual
 Partner _____%
 Corp
 Other (explain)
Federal Employer Identification Number (FEIN) or Social Security Number (SSN) – Application will NOT be processed if missing
State of Colorado Taxpayer Identification Number (TIN) – Application will NOT be processed if missing
Filing Period
 MONTHLY
 QUARTERLY
 ANNUAL
NOTE: If the monthly average for remittance is $40 or greater, monthly filing is required. If less than
$40 per year or fewer than two sales transactions are expected, annual filing is desired.
Date business will begin in Lafayette
If business was purchased, list name of former owner and business name (if name listed above is new)
Sales Tax Contact Name and Title
Business phone number
Business fax number
I, DECLARE, UNDER PENALTY OF PERJURY THAT THIS APPLICATION HAS BEEN EXAMINED BY
ME AND THE STATEMENTS MADE HEREIN ARE MADE IN GOOD FAITH PURSUANT TO THE CITY
OF LAFAYETTE TAX LAWS AND REGULATION AND, TO THE BEST OF MY KNOWLEDGE AND
BELIEF ARE TRUE, CORRECT, AND COMPLETE.
Printed Name
Title
Signature _________________________________________________
Date _________________
Please mail or fax the application to:
City of Lafayette - Sales Tax
PO Box 250
Fax
(303) 665-2153
Lafayette, CO 80026
Phone
(303) 665-5588

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