Application For License, Transient Occupancy Tax - City Of Mesa (Page 2 of 2) in pdf

Application For License, Transient Occupancy Tax - City Of Mesa Page 2

Revenue Collections Operations

Mailing Address

PO Box 1466

Licensing Office

55 North Center Street

Mesa Arizona 85211-1466

Mesa Arizona 85201

(480)644-3999 Fax

(480) 644-2316 Tel

APPLICATION FOR LICENSE, TRANSIENT OCCUPANCY TAX

SECTION I. BUSINESS INFORMATION

Office Use Only

Business Name (Individual, Company or "DBA", first name first)

License #

Street No.

(N,E,S,W )

Street Name

Type

Ste/Apt #

Initials

City

State

ZIP Code + 4

Area Code

Business Telephone #

Start Date

E-mail address

Zoning

State License #

Federal ID #

SECTION II. MAILING ADDRESS & PHONE NUMBER

Enter Name if Different from Section I (above) or Enter 'In-Care-Of' Name

Street No.

(N,E,S,W )

Street Name

Type

Ste/Apt #

City

State

ZIP Code

Area Code

Telephone #

SECTION III. BUSINESS OWNERSHIP & RECORD LOCATION

Ownership:

Individual

LLC

Corp. - State Inc.______

Gen. Partnership

Ltd. Partnership

Other _____________

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

Business Type

Hotel /Motel

R V Park

Other _______________

Apartment

Section V. Management information

Do you have a management company?

Yes

If yes, complete Landlord/Property Manager information

Landlord/Property Manager Name

Address

Phone #

(

)

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.

Print Name

Signature

Title

Date

E\Applications Info Sheets/TOT License Application