Form L-514 - Application For License To Operate Place Of Amusement
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1
2STATE OF SOUTH CAROLINA
1350
1350
DEPARTMENT OF REVENUE
L-514
APPLICATION FOR LICENSE TO
(Rev. 6/26/08)
OPERATE PLACE OF AMUSEMENT
4043
FOR OFFICE USE ONLY
PRINT OR TYPE ALL INFORMATION.
Mail to: SC Department of Revenue
If assistance is needed, call (803) 896-1350
Registration Unit
SID
Upon Completion of Both Sides, Sign and Date.
Columbia, SC 29214-0140
License No.
1. OWNER, PARTNERS OR CORPORATE NAME
2. TRADE NAME (DOING BUSINESS AS)
3. PHYSICAL LOCATION OF BUSINESS REQUIRED (NO P.O. BOX)
4. BUSINESS PHONE NUMBER DAY TIME PHONE NUMBER
STREET
5. FEDERAL IDENTIFICATION NUMBER
CITY
COUNTY (Required)
STATE
ZIP
7. TYPE OF ADMISSION
6. MAILING ADDRESS (IF DIFFERENT)
Night Clubs (02)
Driving Range (07)
Miniature Raceway
Bands (03)
Miniature Golf (08)
Theaters (99)
IN CARE OF
Golf (06)
Auto Racing (24)
Athletic Events
STREET
Other
(See back of form)
CITY
COUNTY
STATE
ZIP
9.
DATE OF BEGINNING ADMISSION CHARGE
Month
Date
Year
8. LOCATION OF RECORDS (No P.O. Box)
10. TYPE OF OWNERSHIP
SOLE PROPRIETOR
UNINCORPORATED ASSOCIATION; ENTER LEGAL NAME
PARTNERSHIP
CORPORATION; ENTER CHARTER NAME
LLC-LLP
OTHER (EXPLAIN)
11. NAMES OF BUSINESS OWNER, PARTNERS OR OFFICERS:
IF PARTNER,
SOCIAL SECURITY NUMBER
NAME/TITLE
ADDRESS
PERCENT OWNED
12. Is business seasonal?
Yes
No
13. If yes, indicate months open
SEASONAL MONTHS
J F M A M J
J
A S O N D
NOTICE: An admissions license will not be issued to a person with any outstanding state tax liability.
STATE OF SOUTH CAROLINA
County of
I,
,
of the
, s
Firm of
wear (or affirm) that the information contained herein is to the best
of my knowledge and belief true and correct.
Sworn to and subscribed before me this
day of
year of
.
(Taxpayer)
(Date)
(Notary Public for S.C.)
40431025
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