Business License Application - City Of Safford Clerk'S Office - Fiscal Year 2011/2012
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1
2BUSINESS LICENSE APPLICATION
Fiscal Year 2011/2012
This application is made for fiscal year ending June 30, 2012.
The signed applicant hereby makes application for City of Safford license to do business within the City of Safford, Graham County, Arizona pursuant to A.R.S. 9-240
(B) (18 & 19) and Chapter 5.04 of the City of Safford Municipal Code.
Please legibly print or type form and submit with payment to the address noted on the back of this form.
Incomplete applications will not be accepted.
BUSINESS INFORMATION:
Owner Name:
Home Phone:
Owner’s Home Address:
City:
State:
Zip:
Firm or Business Name:
Business Phone:
Business Address:
City:
State:
Zip:
Business Mailing Address:
City:
State:
Zip:
:
TYPE OF BUSINESS
□ Professional
□ Wholesale
□ Restaurant
□ Manufacturer □ Contractor
□ Retailer □ Service □ Other
Brief description of business activity:
LICENSE & TAX NUMBERS:
Contractor’s License Number:
(If applicable)
State of Arizona Tax ID Number (TPT#):
(If applicable)
Federal Tax ID Number:
(Federal EIN Number if applicable or owner’s social security number)
MISCELLANEOUS:
□Yes
□No
Are you engaged in more than one business at this location?
□Yes
□No
Do you have additional branches or offices for this business at other locations within Safford?
OWNERSHIP:
□ Individual
□ Partnership
□ Corporation
□ LLC
Type of Ownership:
□Yes
□No
Do you own the property on which the business will be conducted?
EMERGENCY CONTACT PERSONS:
Name:
Address:
City:
State:
Zip:
Phone:
Name:
Address:
City:
State:
Zip:
Phone:
X
Signature of Owner or Applicant
Date
Make Check or Money Order Payable to City of Safford
Mail completed form and payment to City of Safford, Attn: Business Licensing, P.O. Box 272, Safford, AZ 85548
Questions regarding this form? Contact the Business Licensing Office at 928-432-4000
Zoning Office Use Only:
Approved: □ Yes □No Date:
Reviewed for zoning compliance by:
If “No,” reason for disapproval:
Clerk’s Office Use Only:
Receipt Number:
Amount Paid:
□ ca □ ck □ cc
License Number:
Clerk’s Office Staff
Date
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