Form Boe-400-Mt (S2) - Application For Temporary Seller'S Permit

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BOE-400-MT (S2) REV. 5 (5-97)

STATE OF CALIFORNIA

APPLICATION FOR TEMPORARY SELLER’S PERMIT

BOARD OF EQUALIZATION

SECTION I: OWNERSHIP INFORMATION

FOR BOARD USE ONLY

(use additional sheet to include information about additional

1. PLEASE CHECK TYPE OF OWNERSHIP

TAX

OFFICE

NUMBER

co-owners or partners)

Photocopy of

Sole Owner

Husband/Wife Co-ownership

Driver's License and

BUSINESS CODE

AREA CODE

Social Security Card

Partnership

is required

See instruction number 6

PREPARER

VERIFICATION:

Other __________________________________

SSN

Other

Use additional sheet to include information about additional co-owners or partners

Owner/Partner/President

Co-owner/Partner/Vice-President

Partner/Secretary

Partner/Treasurer

2. FULL NAME

(incl. middle name)

3. ADDRESS

(residence)

4. TELEPHONE

(

)

(

)

(

)

(

)

(residence)

5. SOCIAL

SECURITY NO.

6. DRIVER

LICENSE NO.

7. DAYTIME

TELEPHONE

8. SIGNATURE

Section II: Business Information

1. CORPORATION/ORGANIZATION/ASSOCIATION

2. CORPORATE NUMBER

FULL NAME

3. OWNER/CO-OWNERS/PARTNERS

FULL NAME (INCLUDING MIDDLE NAME)

4. PHYSICAL ADDRESS OF EVENT

CITY

STATE

ZIP CODE

5. PERIOD OF EVENT FROM

6. ADMISSION CHARGED

YES

7. WHAT WILL YOU SELL?

7A. HOW MANY SELLING LOCATIONS WILL YOU HAVE? (IF 2 OR MORE, PLEASE ATTACH LIST OF ALL LOCATIONS.)

8. MAILING ADDRESS FOR OWNER/ORGANIZATION

CITY

STATE

ZIP CODE

9. MAIL TO THE ATTENTION OF:

10. DAYTIME TELEPHONE (

)

11. NAME OF BANK

BRANCH LOCATION

ACCOUNT NUMBER

12. SPONSOR OF EVENT

ADDRESS

TELEPHONE

13. COST OF SPACE RENTAL $

14. PROJECTED SALES $

Section III: Certification

The above statements are certified to be correct to the best knowledge and belief of the undersigned, who is duly authorized to sign this application. If

spouse co-ownership, both signatures must appear below.

Title

Signature

Name (typed or printed)

Date

FOR BOARD USE ONLY

Furnished to taxpayer

Security posted

Pamphlet 18

Regulations

_____________

Yes Amount $ _______________