Form Bls-700-028e - Business License Application Page 2
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43. Owner Information
a.
Select only ONE ownership structure:
Sole proprietor
Yes
No
If married, should spouse’s name appear on license?
(If you answer No, you must still enter the
spouse information in section “3f” below.)
Corporation*
Non profit Corporation*
Limited Liability Company*
(educational, religious, charitable)
partnership (
:_____)
Joint Venture
# of partners
Limited partnership*
Limited Liability partnership*
Limited Liability Limited partnership*
*These ownership structures must contact the Secretary of State office for additional filing requirements.
Name of Corporation, LLC, partnership, LLp, LLLp, or Joint Venture Name (examples: aBC, Inc. oR fir Trees Unlimited LLC)
State incorporated/formed: ____________________________
Year incorporated/formed: ____________________________
association
Trust
Municipality
Tribal government
other
Name of organization (example: anderson family Trust)
b.
Provide the ownership structure’s first date of business at this location. Out-of-state businesses should use
Business open Date
the first date of operation in WA. (Required. If unknown, please estimate.)
MM
YY
c.
Is this location inside city limits?
Yes
No
Business Name/Trade Name
d.
Business Mailing address
Business Street address
(Street or PO Box, Suite No. do not use building name)
(if different than mailing) Do not use a PO Box or PMB.
City
State
Zip code
City
State
Zip code
e.
(
)
(
)
Business Telephone Number
fax Number
e-Mail address
f.
List all owners & spouses: Sole proprietor, partners, officers, or LLC members.
(Attach additional pages if needed.)
/
/
___________________________________________________________
__________________
__________________________
___________
Name (Last, First, Middle)
Date of Birth
Social Security Number*
% owned
___________________________________________________________
____________________________________________________________
Home address (Street or PO Box)
City
State
Zip code
(
)
________________________
_________________________________
are you married? Yes No If yes, enter spouse information below.
Title
Home Telephone Number
/
/
___________________________________________________________
__________________
________________________________________
Spouse Name (Last, first, Middle)
Spouse Date of Birth
Spouse Social Security Number*
/
/
___________________________________________________________
__________________
__________________________
___________
Name (Last, First, Middle)
Date of Birth
Social Security Number*
% owned
___________________________________________________________
____________________________________________________________
Home address (Street or PO Box)
City
State
Zip code
(
)
are you married? Yes No If yes, enter spouse information below.
________________________
_________________________________
Title
Home Telephone Number
/
/
___________________________________________________________
__________________
________________________________________
Spouse Name (Last, first, Middle)
Spouse Date of Birth
Spouse Social Security Number*
/
/
___________________________________________________________
__________________
__________________________
___________
Name (Last, First, Middle)
Date of Birth
Social Security Number*
% owned
___________________________________________________________
____________________________________________________________
Home address (Street or PO Box)
City
State
Zip code
(
)
are you married? Yes No If yes, enter spouse information below.
________________________
_________________________________
Title
Home Telephone Number
/
/
___________________________________________________________
__________________
________________________________________
Spouse Name (Last, first, Middle)
Spouse Date of Birth
Spouse Social Security Number*
*The Social Security Number is required for all sole proprietors. It is also required for all partners, officers, and LLC members of businesses that will have
employees, and all owners and spouses of businesses that will have liquor, lottery or private investigator licenses. Not fully completing section “f” will result in
application delays. (RCW 26.23.150, RCW 50.12.070)
BLS-700-028e (11/21/13) page 2 of 4
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