Application For License, Transaction Privilege (Sales) And Use Tax

Application For License, Transaction Privilege (Sales) And Use Tax - City Of Mesa Page 2

QUESTIONNAIRE

All commercial locations with a Mesa location must complete this form and attach to the

Privilege (Sales) and Use Tax application.

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Business Name: ____________________________________________________________

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Business Address: __________________________________________________________

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Do customers physically come to the business location? Yes

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Is there delivery and/or storage of materials, equipment or supplies at the physical business

location? Yes

If yes, please explain.

___________________________________________________________________________

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What type of business activity or work is performed at the business location?

___________________________________________________________________________

Approval of this application is for the limited purpose of granting the applicant a Privilege (Sales) and

Use Tax License to conduct taxable business activities within the City of Mesa. The granting of a

Privilege (Sales) and Use Tax License shall not be construed as an express or implied certification

that the premises upon which the applicant wishes to conduct business activities within the City of

Mesa conforms to applicable City codes. The applicant agrees to comply with all City of Mesa codes

and ordinances with respect to the above named business.

Contact Building Safety to address any code requirements regarding your business location.

They are located at 55 N. Center Street or can be reached by phone at (480) 644-2185.

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I, the below signed, certify that all statements answered on this form are true and

complete.

_______________________________________________

_______________________

Signature of Owner, Partner or Officer

Date

Application For License, Transaction Privilege (Sales) And Use Tax - City Of Mesa Page 2