Form Bls-700-028 - Master Application - State Of Washington Master License Service - 2000 Page 2
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43. Business Information
Please complete the appropriate section for business ownership structure. Attach additional sheets if necessary.
/
Business Open Date ____________
(If unknown, please estimate.)
MM
YY
a.
Please check the one box that applies to your business.
Sole Proprietor: Should spouse’s name appear on license?
Yes
No
)
(if applicable
Partnership
Limited Partnership
Limited Liability Partnership
Limited Liability Company
Washington Corporation
Out of State Corporation
Non Profit Corporation
(educational, religious, charitable )
Partnership, Corporation, LLC or LLP Name
State incorporated/formed:
Year incorporated/formed:
Association
Trust
Municipality
Other
Name of Organization
b.
Inside city limits?
Yes
No
Doing Business As (DBA) /Trade Name
County in Which Business is Located
Business Street Address ( street or route - physical location only )
Business Mailing Address (Street or PO Box , Suite No. Do not use building name)
City
State
Zip
City
State
Zip
(
)
(
)
Business Telephone Number
Fax Number
Internet/E-Mail Address
c.
List all owners: Sole proprietor, partners, officers, and LLC members. Attach additional pages if needed.
Name (Last, First, Middle)
Title
/
/
Home Address (Street or PO Box)
Social Security Number
Date of Birth
% Owned
Home Telephone Number
City
State
Zip
/
/
Social Security Number
Date of Birth
Spouse’s Name (Last, First, Middle)
Name (Last, First, Middle)
Title
/
/
Home Address (Street or PO Box)
Date of Birth
Social Security Number
% Owned
City
State
Zip
Home Telephone Number
/
/
Spouse’s Name (Last, First, Middle)
Social Security Number
Date of Birth
Name (Last, First, Middle)
Title
/
/
Social Security Number
Home Address (Street or PO Box)
Date of Birth
% Owned
City
State
Zip
Home Telephone Number
/
/
Spouse’s Name (Last, First, Middle)
Date of Birth
Social Security Number
Social Security Number is required for all sole proprietors (RCW 26.23.150) and for all persons associated with a business that will
have liquor, lottery, or private investigator licenses, in accordance with the Washington laws regulating those businesses.
Please continue Business Information on page 3.
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BLS-700-028 MASTER BUSINESS APP. (R8/00) OR Page
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