Form Ador 11186 - Transaction Privilege Tax City Only Application
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5TRANSACTION PRIVILEGE TAX CITY ONLY APPLICATION
For use only by Arizona businesses with no employees and/or with business activity taxable only to cities
(residential rental, advertising, etc.). Businesses with employees CANNOT USE THIS APPLICATION.
Businesses with employees MUST use Arizona Joint Tax Application (JT‑1).
IMPORTANT! Incomplete applications will not be processed.
You can register, file
Customer Care and Outreach
• Required information is designated with an asterisk (*).
ARIZONA DEPARTMENT OF REVENUE
and pay for this
• Return completed application AND applicable license fee(s) to address
PO BOX 29032
application online at
Phoenix, AZ 85038-9032
shown at left.
• For licensing questions regarding transaction privilege tax, call Taxpayer
It is fast and secure.
Information & Assistance: (602) 255‑3381
SECTION A: Business Information
1
*
Type of Ownership
Individual
Limited Liability Company
Corporation
State of Inc.
M M D D Y Y Y Y
Partnership
Trust
Date of Inc.
*
*
2
Legal Business Name
3
Federal Employer Identification Number or Social Security Number
4
*
Business Name, “Doing Business As”
5
*
Business Phone No.
(with area code)
*
*
Date Sales Began
6
E-mail Address
7
Date Business Started in Arizona
M M D D Y Y Y Y
M M D D Y Y Y Y
City
State
ZIP Code
8
*
Mailing Address –
number and street. PO Box
County/Region
Country
City
State
ZIP Code
9
*
Location of Tax Records – number and street
(Do not use PO Box or route numbers)
*Name of Company
*Name of Contact
*Phone No.
(with area code)
10
*
Business Type / NAICS Code: Additional Business Types and NAICS Codes available at
Advertising & Related Services / 541800
Residential Rental / 531100
Residential Rental / Property Management Co. / 531311
Other, specify:
/
*
11
Description of Business
SECTION B: Identification of Owners, Partners, Corporate Officer(s)
If you need more space, attach Additional Owner, Partner, Corporate Officer(s) form available at .
*Last Name
First Name
Middle Intl.
*
*
Social Security No.
Title
|
|
*
*
*
*
Street Address
City
State
% Owned
*
*
*
*
ZIP Code
County
Phone Number
Country
(with area code)
*Last Name
First Name
Middle Intl.
*
Social Security No.
*
Title
|
|
*
*
*
*
Street Address
City
State
% Owned
*
ZIP Code
*
County
*
Phone Number
*
Country
(with area code)
*
*
*Last Name
First Name
Middle Intl.
Social Security No.
Title
|
|
*
Street Address
*
City
*
State
*
% Owned
*
*
*
*
ZIP Code
County
Phone Number
Country
(with area code)
FOR AGENCY USE ONLY
CASHIER’S STAMP ONLY. DO NOT MARK IN THIS AREA.
ACCOUNT NUMBER
LIABILITY ESTABLISHED
New
START
DLN
Change
S/E DATE
TRANSACTION PRIVILEGE TAX
Revise
LIABILITY
FEIN
Reopen
ADOR 11186 (5/16)
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Parent category: Financial