Form Boe-400-Mcu - Application For Consumer Use Tax Account - 1997 Page 4
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4BOE-400-MCU (S3B) REV. 5 (5-97)
9.
NAME OF ACCOUNTANT/BOOKKEEPER
ADDRESS
TELEPHONE
Albert Smart
2000 Wall St., Camp, CA
222 000-1234
(
)
10. NAME OF BUSINESS LANDLORD
ADDRESS
TELEPHONE
(
)
11. PROJECTED MONTHLY PURCHASES $
12. PROJECTED MONTHLY TAX $
10,000
675.00
Section III: Certification
The above statements are hereby certified to be correct to the best knowledge and belief
of the undersigned, who is duly authorized to sign this application.
Joe A. Shome
President
SIGNATURE
TITLE
Joe A. Shmoe
03/20/97
NAME (TYPED OR PRINTED)
DATE
FOR BOARD USE ONLY
Furnished to Taxpayer
Reporting Basis
REGULATIONS
X
Security Review
BT-1009
BOE-324-A
BT-1241
BT-598
$
BT-400Y
REG. 1620
By
BT-519
REG. 1700
PAMPHLETS
Approved By
BT-741
Remote Input
Date
By
RETURNS
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