Business License Registration - City Of Jeffersontown
Download a blank fillable Business License Registration - City Of Jeffersontown in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Business License Registration - City Of Jeffersontown with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2CITY OF JEFFERSONTOWN
PRINT FORM
BUSINESS LICENSE REGISTRATION
Pursuant to City Ordinance No. 1233, Series 2008, persons, firms or organizations engaged in any trade or profession
operating in the City of Jeffersontown for profit or gain, to first register with said City.
PLEASE COMPLETE, SIGN, DATE & RETURN WITH $75.00 ANNUAL FEE TO CITY HALL
WITHIN 10 DAYS OR UPON START-UP OF BUSINESS
Type or Print
PLEASE ANSWER ALL QUESTIONS
Type or Print
1. Name:
__________________________________________________________________
(If registering as individual)
2. Corporate or Limited Liability Company (LLC) Name:__________________________________________________
3. Trade Name or D.B.A.
________________________________________________________
(If different than above)
4. Primary Corporate / Business Address:
Street:____________________________________________________________ Phone: ___________________
City, State, Zip:_______________________________________________________ Fax: ____________________
4a. Local Jeffersontown, Kentucky Address (if any):
Street:_________________________________________________ Contact:______________________________
Phone:_________________________________________________ Fax: ________________________________
5. Fed Tax I.D. :_______________________________ 6. If Non-Profit, Tax Exempt # _________________________
7. Enter Social Security Number (SSN) if Individual, Sole Proprietor or Single Member LLC: _____________________
8. Email Address: ________________________________ 9. Website: _____________________________________
10. Nature of Business:____________________________________________________ 11. NAIC #_____________
12. Date business started or will start in Jeffersontown: ___________________ 13. Number of employees: ________
14. Complete it obtaining a previously established business, or if there is a change in the organization has occurred:
Date of change:________________________________ Date employment began:__________________________
Former corporate or business name: ______________________________________________________________
IF BUSINESS EMPLOYS PEOPLE IN JEFFERSONTOWN, THE EMPLOYER MUST FILE QUARTERLY
OCCUPATIONAL TAX RETURNS WITH THE CITY OF JEFFERSONTOWN REVENUE DEPARTMENT
15. Payroll Service Provider: _______________________________________________________________________
Phone:_________________ Fax: _________________ Contact: _______________________________________
16. Corporate / Business Payroll Contact: _____________________________________________________________
Phone:_________________ Fax: _________________ Contact: _______________________________________
17. For additional information or in case of emergency contact:
Name:_________________________________________________ Phone: ______________________________
**
**
PLEASE NOTE
It is the applicant’s responsibility to inform the Revenue Department of any changes in
ownership, addresses, number of employees or termination of business activity. The undersigned (business)
agrees to be responsible for all collection costs and attorney’s fees in connection with any delinquent account.
Signature:_________________________________________________ Date: ________________________________
(FOR OFFICE USE ONLY)
Account Nos:______________________________________________________________________________________
ABC Licensed
Financial Institution
Governmental Agency
Non-Profit
Insp/Permit Approval
Revenue Department
10416 Watterson Trail · Jeffersontown, KY 40299-3749 · (502) 267-8333 · fax (502) 267-0547 · jeffersontownky.gov
rev. 2017-01-03
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal