Form Boe-400-Mcl - Application For Certificate Of Registration Lender Account - 2002
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2BOE-400-MCL (FRONT) (1-02)
STATE OF CALIFORNIA
APPLICATION FOR CERTIFICATE OF REGISTRATION
BOARD OF EQUALIZATION
LENDER ACCOUNT
Use additional sheets to include information for more than two individuals.
SECTION I: OWNERSHIP INFORMATION
FOR BOARD USE ONLY
1. PLEASE CHECK TYPE OF OWNERSHIP/ENTITY
TAX
IND
OFFICE
NUMBER
Sole Owner
Husband/Wife Co-ownership
Corporation
Limited Liability Partnership (LLP)
(Registered
BUSINESS CODE
AREA CODE
Limited Partnership (LP)
to practice law, accounting or architecture)
General Partnership
Limited Liability Company (LLC)
APPLICATION PROCESSED BY
VERIFICATION:
Other (describe)
DL
Other
2. ENTER FULL NAME OF CORPORATION, LP, LLP, LLC PARTNERSHIP OR UNINCORPORATED BUSINESS TRUST
3. FEDERAL EMPLOYER IDENTIFICATION NUMBER (FEIN)
4. CORPORATE, LP, LLP, OR LLC NUMBER FROM CALIFORNIA SECRETARY OF STATE
5. STATE OF INCORPORATION OR ORGANIZATION
CHECK ONE
Officer
Manager
Member
Trustee
Beneficiary
Partner
Sole Owner or Co-Owner
6. FULL NAME (first, middle, last)
7. TITLE
8. SOCIAL SECURITY NUMBER (corporate officers excluded)
9. DRIVER LICENSE NUMBER (attach verification)
10. RESIDENCE ADDRESS (street, city, state, zip code)
11. RESIDENCE TELEPHONE NUMBER
(
)
CHECK ONE
Officer
Manager
Member
Trustee
Beneficiary
Partner
Co-Owner
12. FULL NAME (first, middle, last)
13. TITLE
14. SOCIAL SECURITY NUMBER (corporate officers excluded)
15. DRIVER LICENSE NUMBER (attach verification)
16. RESIDENCE ADDRESS (street, city, state, zip code)
17. RESIDENCE TELEPHONE NUMBER
(
)
SECTION II: BUSINESS INFORMATION
Check here if you have included a copy of your partnership agreement
18. BUSINESS NAME [DBA] (complete if different than entity name)
19. PARTNERSHIP NAME (if any)
20. BUSINESS ADDRESS (street, city, state, zip code) [do not list P.O. Box or mailing service]
21. BUSINESS TELEPHONE NUMBER
(
)
22. MAILING ADDRESS (street, city, state, zip code) [if different from business address]
23. FAX NUMBER
(
)
24. RETAILER — PROVIDE SELLER’S PERMIT NUMBER
25. OWNERSHIP CHANGES
Are you changing from one type of business organization to another (for example, from a sole owner to a corporation or from a
partnership to a limited liability company, etc.)?
Yes
No
If yes, complete items 26 and 27 below.
Other:
Are you buying an existing business?
Yes
No
If yes, complete items 26 and 27 below.
26. FORMER OWNER’S NAMES
27. FORMER OWNER’S PERMIT NUMBER
28. NAME & LOCATION OF BANK OR OTHER FINANCIAL INSTITUTION (note whether business or personal)
29. ACCOUNT NUMBER(S)
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