Transaction Privilege (Sales) And Use Tax Application - City Of Mesa 2005 printable pdf download

Special Licensing Office

Mailing Address

55 North Center Street

PO Box 1466

Mesa Arizona 85201

Mesa Arizona 85211-1466

(480) 644-2316 Tel

(480)644-3999 Fax

TRANSACTION PRIVILEGE (SALES) AND USE TAX APPLICATION

NON-REFUNDABLE $50.00 DUE AT THE TIME OF APPLICATION

Business Name Change - License # ______________

New Business

Check one:

Change of Business Location - License #_______________

New Owner of Existing Business

Former Owner Name (if applicable)

Office Use Only

Start Date in Mesa (REQUIRED)

License #

SECTION I. BUSINESS INFORMATION

Business Name (DBA)

Business Address

SIC Code

City

State

Zip Code

Business Phone Number (including area code)

Zoning

Corporate Name (if applicable)

District

Corporate Address (City, State, Zip)

Initials

State License #

Federal ID #

E-mail address

SECTION II. MAILING ADDRESS & PHONE NUMBER

Enter Nam e if Different from S ection I (above) or E nter 'In-Care-Of' N am e

For Multiple

Street No.

(N,E ,S ,W )

S treet N am e

Type

S te/A pt #

Locations in Mesa

City

S tate

ZIP C ode

A rea C ode

Telephone #

Consolidate with

SECTION III. BUSINESS OWNERSHIP & RECORD LOCATION

Mesa License #

Other _______

Ownership:

Individual

LLC

Corporation - State ______

Partnership

Ltd. Partnership

Name

Title

Owners, Partners,

LLC Members, or

Home Address

Social Security #

Officers

(For Additional Names,

City

State

ZIP Code

Phone No.

Please Attach List)

(

)

Name

Title

Home Address

Social Security #

City

State

ZIP Code

Phone No.

(

)

Name

Phone No.

Corporate or LLC

(

)

Statutory Agent

Name

Phone No.

Location Where

(

)

Business Records

Address

City

State

ZIP Code

Are Kept

Section IV. Business Type

Retail Sales

Amusement

Use Tax

Restaurant/Bar

Job Printing

Business Type

Const/Contracting

Hotel/Motel

Personal Property Rental

Residential Rental

Comm'l Rental

Tele-communications

Advertising/Publishing

Describe Nature of

Contractors #

Business

Cash

Accrual

Check method you will use in submitting reports:

Section V. Business Premises Status

Yes

Check one:

Do you own your business location?

If yes, is this your residence?

Yes

If no, complete Landlord/Property Manager information

Landlord/Property Manager Name

Address

Phone #

(

)

Yes

Do you rent a portion of the business premises to another entity?

I certify that the statements made in this application are true and complete to the best of my knowledge. I accept the license authorized and issued in

response to this application with the condition that I report timely and pay any and all taxes due by me to the city. Incomplete forms may not be processed.

IF APPLICABLE, BE SURE ALL TAX HAS BEEN PAID BY FORMER OWNER. BY LAW YOU MAY BE LIABLE FOR ANY UNPAID TAX.

P rin t N a m e

S ig n a tu re

T itle

D a te

Update: Aug 2005