Form Bk209 - Application For New Business Tax License - Hamilton County Clerk

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HAMILTON COUNTY CLERK
FOR OFFICE USE ONLY
THIS APLICATION ALONG WITH
PROPER REMITTANCE MUST BE
Date Receive ______________________________
Room 201, Hamilton County Courthouse
MAILED TOT HE COUNTY CLERK’S
Class ____________________________________
Chattanooga, TN 37402
OFFICE.
Code ____________________________________
423/209-6500
Account # ________________________________
APPLICATION FOR NEW BUSINESS TAX LICENSE
As Required by Title 67, Chapter 4, Part 7, “Tennessee Code Annotated”
1. EXACT BUSINESS NAME AND LOCATION
2. BUSINESS MAILING ADDRESS
Name (give trade name at this location)
Name (enter corporate if applicable)
Street, Highway, (Do Not Use P.O. Box)
Street, Highway, Route or P.O. Box Number
City
State
Zip
City
State
Zip
3. Business Phone Number (INCLUDE AREA CODE)
4. Federal Employers I.D. No.
Applied for
Not Required
4 State Sales Tax Number
Applied for
Not Required
6. Type of Ownership
Proprietorship
Partnership
Other
Corporattion-Enter date of incorporation or domestication in Tennessee: ________________________
Name of corporation___________________________________________________________________________________________________________________
7. Identify owners, officers and/or partners (attach additional names, addresses, phone No.’s and social security No.’s on separate sheet of paper)
Social Security No.
(1) Name
Home Phone No.
Address (not P.O. Box) Street Address
City
State
Zip
(2) Name
Home Phone No.
Social Security No.
Address (not P.O. Box) Street Adress
City
State
Zip
8. Describe the exact business activity at this location, stating the major prodicts and or services sold:
9. OPENING DATE OF BUSINESS AT THIS LOCATION:
Is the business
Retail
Wholesale
Both
Manufacturer
Amusement
Percent _________ % Wholesale
Percent _________ % Retail
11.
Do you operate more than one business location in Hamilton County and
10.
Using the BUSINESS ACTIVITY CODE listing attached to this application,
Tennessee? (If yes, attach add’l. names & addresses)
enter the code number that best describes
No
your type of business operation.
Yes - How many additional locations?
12.
REASON FOR FILING THIS APPLICATION:
starting new business
change in corporate structure
change in ownership of, or the purchase of an existing business. enter the name of the business. Enter the name of the busienss you are purchasing.
13. This application must be received within 20 days from the commencement date of business or penalty and interest apply *
15.00
* Minimum Fee ............................................................................................................................................................................................................... $ _______________
* Penalty - (5% for each 30 days or fraction thereof not to exceed 25% ....................................................................................................................... $ _______________
* Interest - (
Per annum from delinquent date until paid) (
x No. days deliquent) ............................................................................ $ _______________
5.00
* Registration Fee ---------------------------------------------------------------------------------------------------------------------------------------------------------- $ _______________
* Total payment due. MAKE CHECK IN THIS AMOUNT ........................................................................................................................................ $ _______________
14.
THE STATEMENTS MADE IN THIS APPLICATION ARE TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF.
This application must be signed by the individual/owner, or by a partner, or by an officer of the corporation.
By:____________________________________________ Title________________________________________ Date_________________________________
Signature of owner, partner, or corporation officer
BK209 (Rev. 5-95)

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