Form Bls-700-028 Mba - Master Application

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Master License Service
Owner Name
Department of Licensing
P O Box 9048
Unified Business Identifier (UBI)
Olympia WA 98507-9048
Telephone: (360) 664-1400
Federal Employer Identification Number (FEIN)
Information provided may be subject to disclosure
under the public disclosure law (RCW 42. 56)
For Validation - Office Use Only
MASTER APPLICATION
RESET
(Please type or print clearly in dark ink.)
Mail Directly to the Master License Service
or file in person at any UBI service location.
01P-400-925-0003
1. Purpose of Application
Please check all boxes that apply
!
!
Open/Reopen Business
Hire Employees
complete sections 2, 3, (4 if hiring employees) and 5
complete all sections
!
!
Change Ownership
Hire Employees Under Age 18
complete sections 2, 3, (4 if you have employees) and 5
complete all sections
!
!
Add License/Registration to Existing Location
Hire Persons to Work in or Around Your Home
complete sections 2, 3 and 5
complete sections 2, 3c, 4 and 5 (no application fee)
!
!
Register Trade Name
Other
complete sections 2, 3 and 5
complete all sections
!
Change Trade Name -
complete sections 2, 3 and 5
indicate name to be cancelled:
!
Change or Open Location -
complete sections 2, 3a, 3b, 3c and 5
indicate old address to be closed:
2. Licenses and Fees
Use the License Fee Sheet for the information needed to complete this list
Fees Due
Indicate Registrations Needed
!
!
!
No Fee
Tax Registration – Do you want a s
eparate tax return for each business/trade name?
Yes
No
!
No Fee
Industrial Insurance
(if you will have employees)
!
No Fee
Unemployment Insurance
(if you will have employees)
!
No Fee
Minor Work Permit
(if you will have employees under age 18)
!
$ 5.00
New Trade Name (Doing Business As):
Indicate Other Licenses ( such as Lottery Retailer) or additional Trade Names ($5 each name):
(see License Fee Sheet for more information.)
$
$
$
$
$
$
Enclose check for total amount due, including the
15.00
$
Application Fee
Application Fee, which MUST be submitted with this form
" " " " "
$
WASHINGTON STATE TREASURER.
Make check payable to the
Total Amount Due
If you need assistance through the telecommunications device for the deaf, please call TTY (360)664-8885.
To request this document in an alternate format for the visually impaired, call (360)664-1400.
BLS-700-028 MBA (R/06/06) OR/W Page 1 of 4

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