Tax / Fee Application - Accounts Receivable Office
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1
2CITY OF PEORIA, ILLINOIS
TAX / FEE APPLICATION
Business /
Local
Trade Name:
Phone #:
(
)
#
Street
City
State
Zip Code
Location
Address:
#
Street
City
State
Zip Code
Mailing Address:
(if other than above)
Number of business sites within the City of Peoria:
List each site individually. Use additional sheets if necessary.
Business Site Name
Address
State of Illinois ROT #
FEIN or Social
(Sales tax number):
Security Number:
Type of Ownership
(Circle one):
Sole Proprietorship
Corporation
Partnership
Other:
If Corporation:
Date of incorporation: ________/________/________
State of incorporation: ______________________________________________
Address of corporate offices:
Corporate name:
Are you authorized to do business in the State of Illinois? _______________
Name and address of Illinois registered agent:
____________________________________________________________________________________________________________________________
List owner, corporate officers or general partners: (Use additional sheets if necessary.)
Name
Title
Residential Address
Person who will be submitting tax / fee returns:
Name
Title
Business Address
Fax number: (
)
Phone number: (
)
E-mail Address:
Date first taxable sale was made or
date first taxable sale is anticipated to be made:
COMPLETE REVERSE SIDE
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Parent category: Financial