Form Boe-400-Mip - Application For Seller'S Permit And Registration As A Retailer (Individuals/partnerships) - 2003
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BOE-400-MIP (FRONT) REV. 18 (1-03)
STATE OF CALIFORNIA
APPLICATION FOR SELLER’S PERMIT AND REGISTRATION
BOARD OF EQUALIZATION
AS A RETAILER (INDIVIDUALS/PARTNERSHIPS)
Use additional sheet(s) to include information for more than two partners
FOR BOARD USE ONLY
SECTION I: OWNERSHIP INFORMATION
1. PLEASE CHECK TYPE OF OWNERSHIP
TAX
IND
OFFICE
NUMBER
Sole Owner
Husband/Wife Co-ownership
SR
General Partnership
Limited Partnership
Provide documents if filed with Secretary of State.
BUSINESS CODE
AREA CODE
Limited Liability Partnership
(registered to practice law, accounting or
architecture) Provide documents filed with Secretary of State.
Enter Federal Employer Identification Number (FEIN), if any
APPLICATION PROCESSED BY
VERIFICATION:
DL
Other
OWNER OR PARTNER
2. PARTNERSHIP NAME (if applicable)
3.
Did you include a copy of your partnership
agreement?
Yes
No
4. FULL NAME (first, middle, last)
5. SOCIAL SECURITY NUMBER
6. DRIVER LICENSE NUMBER (attach verification)
7. RESIDENCE ADDRESS (street, city, state, zip code)
8. RESIDENCE TELEPHONE NUMBER
(
)
9. NAME, ADDRESS & TELEPHONE NUMBER OF A PERSONAL REFERENCE WHO DOES NOT LIVE WITH YOU
CO-OWNER OR PARTNER
10. FULL NAME (first, middle, last)
11. SOCIAL SECURITY NUMBER
12. DRIVER LICENSE NUMBER (attach verification)
13. RESIDENCE ADDRESS (street, city, state, zip code)
14. RESIDENCE TELEPHONE NUMBER
(
)
15. NAME, ADDRESS & TELEPHONE NUMBER OF A PERSONAL REFERENCE WHO DOES NOT LIVE WITH YOU
SECTION II: BUSINESS INFORMATION
16. BUSINESS NAME [DBA] (complete if different than entity name)
17. BUSINESS ADDRESS (street, city, state, zip code) [do not list P.O. Box or mailing service]
18. BUSINESS TELEPHONE NUMBER
(
)
19. MAILING ADDRESS (street, city, state, zip code) [if different from business address]
20. BUSINESS FAX NUMBER
(
)
21. DATE YOU WILL BEGIN BUSINESS ACTIVITIES (month, day & year) 22. TYPE OF ITEMS SOLD
23. NUMBER OF SELLING LOCATIONS
(if 2 or more, attach list of all locations)
24. TYPE OF BUSINESS (check one that best describes your business)
CHECK ONE
Retail
Wholesale
Mfg.
Repair
Service
Construction Contractor
Full Time
Part Time
25. OWNERSHIP CHANGES
Are you buying an existing business?
Yes
No If yes, complete items 26 through 30 below.
Are you changing from one type of business organization to another (for example, from a sole owner to a general partnership or from a general
partnership to a limited liability company, etc.)?
Yes
No
If yes, complete items 28 and 29 below.
Other:
26. PURCHASE PRICE
27. VALUE OF FIXTURES & EQUIPMENT
$
$
28. FORMER OWNER’S NAME
29. SELLER’S PERMIT ACCOUNT NUMBER
30. IF AN ESCROW COMPANY IS REQUESTING A TAX CLEARANCE ON YOUR BEHALF, PLEASE LIST THEIR NAME, ADDRESS, TELEPHONE NUMBER AND THE ESCROW NUMBER
31. DO YOU MAKE INTERNET SALES?
32. WEBSITE ADDRESS
Yes
No If yes, answer 32.
Application for Seller’s Permit ! Individuals/Partnerships (1-03)
Continued on Reverse
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