Form Boe-400-Mcu - Application For Consumer Use Tax Account - 1997 Page 3
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4BOE-400-MCU (S3F) REV. 5 (5-97)
STATE OF CALIFORNIA
APPLICATION FOR CONSUMER USE TAX ACCOUNT
BOARD OF EQUALIZATION
FOR BOARD USE ONLY
SECTION I: OWNERSHIP INFORMATION
TAX
OFFICE
NUMBER
SAMPLE
S
1. PLEASE CHECK TYPE OF OWNERSHIP
Photocopy of
Driver's License and
Sole Owner
Husband/Wife Co-ownership
BUSINESS CODE
AREA CODE
Social Security Card
X
Corporation
Partnership
is required
PREPARER
VERIFICATION:
See instruction number 6
Other _______________________
SSN
DL
Other
2.
IF CORPORATION, ENTER FULL CORPORATE NAME. IF LIMITED LIABILITY COMPANY (LLC), ENTER FULL LLC NAME.
Smiles, Inc.
3.
FEDERAL EMPLOYER IDENTIFICATION NUMBER (FEIN)
4. CORPORATE OF LLC NUMBER/STATE OF INCORPORATION OR ORG.
22-3344555
9999999-California
Please check appropriate title and use additional sheet to include information about additional co-owners or members.
OWNER
PARTNER
CO-OWNER
PARTNER
PARTNER
SECRETARY
PARTNER
TREASURER
X
X
PRESIDENT
MANAGER
VICE-PRESIDENT
MANAGER
MEMBER
MANAGER
MEMBER
MEMBER
MANAGER
MEMBER
5. FULL NAME
Joe A. Shmoe
Jan B. Jacks
(incl. mid. name)
123 P. Street
777 N. Rd.
6. ADDRESS
(residence)
Camp, CA
Camp, CA
7. TELEPHONE
(
222 333-6789
)
(
222 999-1234
)
(
)
(
)
(residence)
8. DAYTIME
222 111-6666
222 111-6666
(
)
(
)
(
)
(
)
TELEPHONE
9. SOCIAL
987-65-4321
123-45-6789
SECURITY NO.
10. DRIVER’S
C7654209
C3456789
LICENSE NO.
Joe A. Shmoe
Jan B. Jacks
11. SIGNATURE
Section II: Business Information
1.
BUSINESS NAME
BUSINESS TELEPHONE
Smiles, Inc.
222 111-6666
(
)
2.
BUSINESS ADDRESS (Do not use P.O. Box or address of mailing service)
CITY
STATE
ZIP CODE
88 Wrong Way
Camp
CA
12345
3.
MAILING ADDRESS (If different from no. 2 above)
CITY
STATE
ZIP CODE
4.
DESCRIPTION OF BUSINESS
b. Type of business
X
Building Contractor
a. Items sold or service performed
Manufacturing
Professional or
Construction
General
or wholesaling
personal service
contractor
5.
WHAT WILL YOU PURCHASE FROM OUT-OF-STATE?
6.
DATE PURCHASES BEGAN IN CALIFORNIA:
Fixtures
April
01
1997
Month
Day
Year
7.
NAME OF BANK OR OTHER FINANCIAL INSTITUTION (checking and savings account) BRANCH LOCATION
ACCOUNT NUMBER
Bank of USA
West Branch
000-0068380
8.
MAJOR SUPPLIERS
ADDRESS
ITEMS PURCHASED
Ray’s Building Surplus
North, CA
Fixtures
Continued on Reverse
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