Application For Registration Tax On Prepared Food And Beverage - City Of Hopewell

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Application for Registration Tax on
Prepared Food and Beverage
Separate Application Required for Each Location
Legal Business Name____________________________________ SSN/FEIN_______________
Trade Name____________________________________________________________________
Class
Restaurant
Caterer
Convenience Store
Other_______________
Business Location Address________________________________________________________
Mailing Address________________________________________________________________
Telephone No._________________ Fax No._________________ Cell No._________________
Persons Responsible for Filing Returns:
Name
Title
___________________________________
____________________________________
___________________________________
____________________________________
___________________________________
____________________________________
Date Started or to Start at this Location______________________________________________
Bank Information______________________________________________________________________
The undersigned certifies that this information is true and accurate to the best of his/her knowledge.
Signature_________________________________________
Date______________________
Title_____________________________________________
Office hours: 8:30 a.m. – 5 p.m.
Phone # (804) 541-2237
Fax # (804) 541-2207
Please mail this form to:
Commissioner of the Revenue
PO Box 1604
Hopewell, VA 23860

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