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DR-1S

R. 07/12

Page 3

Business Structure and ownership (check one):

Sole proprietorship - An unincorporated business that is

Corporation - A person or group of people who

owned by one individual.

incorporate by receiving a charter from their state’s

Secretary of State (includes professional service

Partnership - The relationship existing between two or more

corporations).

entities or individuals who join to carry on a trade or business.

This includes a business jointly owned/operated by a husband

Check one:

C-corporation

and wife.

S-corporation

Check one:

General partnership

Not-for-profit corporation

Limited partnership

Limited liability company - Two or more entities (or

Joint venture

individuals) who file articles of organization with their

state’s Secretary of State.

Married couple

Check one:

Single-member LLC

Multi-member LLC

Check here if you elected to be treated as a corporation

for federal income tax purposes.

10.

Corporations, partnerships, limited liability companies must provide the following:

a. Fiscal year ending date:

month

day

b. Document/registration number issued by the Florida Secretary of State when the business was

Note:

chartered or authorized to conduct business in Florida:

If you are not incorporated,

________________________________________________________________________

chartered or registered to do

business in Florida, you may

c. Date of incorporation, formation or organization, or date of authorization to

be required to do so. For more

conduct business in Florida:

information, go to the Florida

Department of State’s Internet

site at or call

850-488-9000.

month

day

year

11 a. If the business is incorporated in another state, provide the name of the state: ___________________________________________

b. If the business is a corporation, provide the registered agent’s contact information:

Registered agent’s name: _______________________________________________________________________________________

Registered agent’s street address: _______________________________________________________________________________

Registered agent’s City/State/ZIP: ________________________________________________________________________________

Registered agent’s telephone number (include area code) ___________________________________________________________

12.

Ownership Information: Provide the full name, title, FEIN or SSN (if an FEIN is not required for your business entity, the SSN of

the owner is required), and address and telephone number of each corporate officer, owner, general partner, stockholder and/or

director with a controlling interest. Make copies of this page if additional space is needed.

Name

Street address

City/State/ZIP or

SSN or FEIN

Telephone number

Title

Foreign Country/Postal Code

( _ _ _ ) _ _ _ - _ _ _ _

Form Dr-1s - Registration Application For Secondhand Dealers And/or Secondary Metals Recyclers Page 3

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