Cc Form 33 - License Application For Transaction Privilege & Use Tax - 2009
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1City of Chandler
APPLICANT USE
License Application
AMOUNT DUE
For Office Use Only
Telephone: 480-782-2280
Transaction Privilege & Use Tax
Mailing Address: MS 701, PO Box 4008, Chandler, AZ 85244-4008
APPLICATION
Location address: 175 S. Arizona Ave, Suite A, Chandler, AZ 85225
FEE $15.00 +
New Business
Former Owner (if applicable)
Previous City License #
Check one:
LICENSE FEE
New Owner of Existing Business
Current City License #
Date of Change
$_______________
Name Change Only
Check any
Location Change
SEE FEE
that apply:
SCHEDULE
SECTION I. BUSINESS INFORMATION
Business Name (Individual, Company or "DBA", first name first):
TOTAL PAYMENT
Business Location Address:
$_______________
BUSINESS
City, State, Zip Code + 4:
Business Phone (Including Area Code):
START DATE IN
CHANDLER IS
MANDATORY
E-mail address:
State Tax License #:
Federal ID #:
Start Date (in Chandler):
FEES ARE NOT
REFUNDABLE
SECTION II. MAILING ADDRESS & PHONE NUMBER
Enter Name if Different from Section I (above) or Enter Care-Of Name:
Prior Year
License & Late
Mailing Address:
Fees May Apply
City, State, Zip Code + 4:
Phone (Including Area Code):
For Office
Use Only
SECTION III. BUSINESS OWNERSHIP & RECORD LOCATION
Business Class Codes:
Ownership:
Individual
LLC
Corp. - State Inc.______
Gen. Partnership
Ltd. Partnership
Other _____________
Name
Title
NAICS Code:
Owners, Partners,
LLC Members, or
Home Address
Social Security #
Filing Freq.
Officers
M
Q
A
C
(For Additional Names,
City
State
ZIP Code
Phone No.
Master Lic. #:
Please Attach List)
Name
Title
Entered By:
Home Address
Social Security #
Zoning Appr. Date:
City
State
ZIP Code
Phone No.
LAWA:
Name
Phone No.
Approved By:
Date:
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
Restaurant/Bar
Amusement
Construction Contracting
Use Tax
Wholesaler
Business Type
Manufacturer
Commercial Rental
Residential Rental (# of Units ______ )
Hotel/Motel
Other_________________
Contractors #
Describe Nature of
Business
Check method you will use in submitting reports:
Cash Receipts
Accrual
Number of Employees:
SECTION V. BUSINESS PREMISES STATUS
Do you own your business location?
Yes
No
If yes, is this your residence?
Yes
No
If no, complete Landlord/Property Manager information:
Landlord/Property Manager Name
Address
Phone #
Do you rent a portion of the business premises to another entity?
Yes
No
I certify that the statements made in this application are true and complete to the best of my knowledge. I accept the permit 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 SALES TAX HAS BEEN PAID BY FORMER OWNER. BY LAW YOU MAY BE LIABLE FOR ANY UNPAID TAX.
Print Name
Signature
Title
Date
CC Form 33
Rev. Oct-10
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