Biennial Retail Sales Tax License Application Or Business Registration Application - City Of Centennial Page 2
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2City of Centennial, CO
License Application, Continued
Registered Agent:
16
Name
Title
Street Address
City
State/Zip
Phone
CONFIDENTIAL
SECTION TWO: All information provided in this section must be provided only if applying for a sales tax and not if applying
for a general business license. Information with an asterisk (*) is considered confidential and will not be publicly released
unless the City is legally required to do so by law, regulation or court order.
Retail Sales Tax Filing Frequency (if applicable). Please check the appropriate box.
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*
— Tax due is $300 or more
MONTHLY FILING
(
6
):
SEASONAL
SALES OCCUR DURING LESS THAN
MONTHS PER YEAR
— Monthly tax due is $10 to $299
QUARTERLY FILING
OR
Seasonal monthly filing for the months of:
— Annual tax due is less than $100
ANNUAL FILING
– Business License Only
_____________________ to _______________________
NOT APPLICABLE
State of Colorado Sales Tax License No.:
Federal Employer I.D. (FEIN):
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List Owner(s) or Corporate Officers: (attach supplemental sheet, if necessary)
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Name and *Social Security Number
Position
*Home Phone
*Date of Birth
*Home Address
City
State/Zip
Name and *Social Security Number
Position
*Home Phone
*Date of Birth
*Home Address
City
State/Zip
,
.
PLEASE PROVIDE THE FOLLOWING INFORMATION
IF APPLICABLE
Former Name of Business:
Date of Purchase:
20
Yes
No
Did the purchase price include fixed assets, machinery, or equipment?
Value $
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SECTION THREE: All applicants must complete and sign this section.
Please be sure to check with other departments of the City of Centennial to ensure compliance with all other applicable laws
and regulations. By issuance of the Business Registration or Retail Sales Tax License, the City makes no representation
regarding conformity with zoning provisions and/or other requirements
YES NO
Please contact me regarding information on a Zoning Compliance Review. (Please check a box.)
I declare, under penalty of perjury in the second degree, that this application has been examined by me and statements made herein
are made in good faith pursuant to Colorado and the City of Centennial tax laws and regulations, and to the best of my knowledge
and belief are true, correct, and complete.
Signed:
Title:
(
Must be person that is legally responsible for the business (i.e., owner, partner, officer, etc.)
Printed Name:
Date:
This application is in accordance with Sections 4-1-500 and 6-1-30 of the City of Centennial Municipal Code.
When opening a new business in the State of Colorado, call the Colorado Business Assistance Center
(303) 592-5920 or visit:
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