Business License Application - North Pole - Alaska Page 2
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4OWNER INFORMATION
For a Sole Proprietor or Partnership, this information must be completed for all legal owners. For a Corporation, this
information must be completed for all Corporate Officers (i.e. President, Vice President, Secretary and Treasurer). Social
.
Security number is optional
1.
Name
Title
Social Security Number
Telephone Number
Home Address
Mailing Address
2.
Name
Title
Social Security Number
Telephone Number
Home Address
Mailing Address
3.
Name
Title
Social Security Number
Telephone Number
Home Address
Mailing Address
4.
Name
Title
Social Security Number
Telephone Number
Home Address
Mailing Address
INDIVIDUAL RESPONSIBLE FOR SALES TAX INFORMATION
(1) The individual responsible for the records and sales made by the business and such other books or accounts as may be
necessary to determine the amount of tax the business must pay to the City (owner, partner, manager, bookkeeper, etc.)
Social Security number is optional.
Name
Title
Social Security Number
Telephone Number
Home Address
Mailing Address
(2) The individual who calculates, holds for the benefit of the City, and transmits to the City the amount of tax collected by
the business each month (bookkeeper, manager, owner, etc.) Social Security number is optional.
Name
Title
Social Security Number
Telephone Number
Home Address
Mailing Address
(3) The individual who will file the tax returns for the business with the City each month (bookkeeper, manager, owner, etc.)
Social Security number is optional.
Name
Title
Social Security Number
Telephone Number
Home Address
Mailing Address
I HEREBY CERTIFY that the statements made herein have been examined by me, and are, to the best of my knowledge and
belief true and complete.
Name
(Must be signed by Owner, Partner, or Corporate Officer)
Title
Revised 12/10
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