Form 83-T-5 - Business Tax Account Number And Business Privilege License - Application For Philadelphia
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1PHILADELPHIA BUSINESS TAX ID NUMBER
APPLICATION FOR PHILADELPHIA
CITY OF PHILADELPHIA
DEPARTMENT OF REVENUE
BUSINESS TAX ACCOUNT NUMBER
DEPARTMENT OF LICENSES AND INSPECTIONS
CONCOURSE LEVEL
AND
PHILADELPHIA BUSINESS LICENSE NUMBER
1401 JOHN F KENNEDY BOULEVARD
PHILADELPHIA, PA 19102
BUSINESS PRIVILEGE LICENSE
PLEASE SEE REVERSE SIDE FOR INSTRUCTIONS BEFORE ANSWERING ANY QUESTIONS ON THIS FORM
1. APPLICANT NAME
1A. TRADE NAME (IF APPLICABLE)
2. BUSINESS ADDRESS (NUMBER AND STREET)
CITY
STATE
ZIP CODE
3. MAILING ADDRESS, IF DIFFERENT FROM ABOVE (NUMBER AND STREET)
CITY
STATE
ZIP CODE
4. BRANCH OFFICE ADDRESS (IF ANY)
CITY
STATE
ZIP CODE
5. BUSINESS TELEPHONE NUMBER
6. HOME TELEPHONE NUMBER
DEPARTMENT OF REVENUE USE ONLY
(
)
(
)
7. FEDERAL EMPLOYER IDENTIFICATION NUMBER/SOCIAL SECURITY NUMBER
8. PA. STATE SALES TAX NUMBER
9. TYPE OF ORGANIZATION (CHECK ONE)
o
o
o
o
INDIVIDUAL
PARTNERSHIP
JOINT VENTURE
ASSOCIATION
o
CORPORATION
STATE INCORPORATED
DATE INCORPORATED
o
NON-PROFIT 501(c)(3) IF A NON-PROFIT ORGANIZATION, PLEASE ATTACH A COPY OF CHARTER.
o
OTHER TYPE OF ORGANIZATION
10. IF BUSINESS WAS OBTAINED FROM A PREVIOUS OWNER OR IF YOUR BUSINESS CHANGED, I.E. INDIVIDUAL TO A PARTNERSHIP, ETC. GIVE
NAME OF PREVIOUS OWNER
DATE OF CHANGE
11. DESCRIBE EXACT TYPE OF BUSINESS
12. DATE PHILADELPHIA OPERATION BEGAN
13. NUMBER OF EMPLOYEES
13A. EMPLOYMENT START DATE
14. MONTHLY PAYROLL
15. PUC LICENSE NO.
(SEE INSTRUCTIONS)
(SEE INSTRUCTIONS)
(SEE INSTRUCTIONS)
16. ICC LICENSE NO.
17. INDIVIDUALS, PARTNERS OR OFFICERS NAME
19. SOCIAL SECURITY NUMBER
18. HOME ADDRESS
20. ACCOUNTING BASIS
21. ACCOUNTING PERIOD
o
o
o
o
o
CASH
ACCRUAL
OTHER (TYPE):
CALENDAR YEAR
FISCAL YEAR ENDING:
22. NAME & ADDRESS OF PERSON, AGENT OR FIRM KEEPING BOOKS
I understand that if I knowingly made any false statement herein I am subject to such penalties as may be prescribed by law.
(DATE)
(SIGNATURE)
(TITLE)
D
R
I
EPARTMENT OF
EVENUE
NFORMATION:
P
B
P
L
HILADELPHIA
USINESS
RIVILEGE
ICENSE
(215) 686-6600
l F
(215) 686-6635
AX
REVENUE CODE 3702
Visit our internet site at
:
D
L
I
I
FEE $200.00
EPARTMENT OF
ICENSES AND
NSPECTIONS
NFORMATION:
(215) 686-2490
83-T-5 (Rev. 7/99)
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