Form 001 - Bltc Application - Application For Business License Tax Certificate Page 2
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1
2CITY OF SEATTLE
APPLICATION FOR BUSINESS LICENSE TAX CERTIFICATE - Page 2
NATURE OF BUSINESS:
Check all that apply and provide detail below. This information should be as detailed as possible.
Manufacturing-Extracting
Printing & Publishing
Tour Operator
Wholesale
Retail
Service
Transportation
Other
Utility Services
Charging Admission for Events/Shows
Gambling Activity
DOES YOUR BUSINESS OWN OR OPERATE PRICE SCANNING EQUIPMENT?
YES
NO
DESCRIBE IN DETAIL THE PRINCIPAL PRODUCT(s) OR SERVICE(s) RENDERED:
NOTE: Additional licenses or endorsements may be required depending on the business activity - please see instruction sheet under regulatory licenses.
NAME(S) OF SOLE PROPRIETOR, PARTNERS, CORPORATE OFFICERS, AND RESIDENT AGENTS:
List true name(s), residence address,
telephone number and date of birth of the sole proprietor or all partners or corporate officers/directors and their titles (attach a separate sheet, if needed).
NAME AND TITLE
RESIDENCE ADDRESS
CITY, STATE, ZIP
TELEPHONE
TAX REPORTING STATUS -
Seattle BUSINESS LICENSE TAX FORMS must be filed by every business, EVEN IF NO TAX IS DUE.
Based on the taxable revenue for your business as described below, please check one of the following reporting frequencies:
QUARTERLY -
Estimated ANNUAL taxable revenue is expected to be $150,000 or more.
ANNUAL -
Estimated ANNUAL taxable revenue is expected to be less than $150,000.
A Business granted ANNUAL reporting status by License & Tax Administration must file a combined tax return if there is more than one location.
If applicable, tax forms are mailed to the last known address - failure to receive the form does not preclude the requirements to file timely.
IF YOU PURCHASED THIS BUSINESS, DID YOU TAKE OVER
THE ENTIRE BUSINESS
ONLY A PORTION
FORMER OWNER'S NAME
CURRENT ADDRESS
CITY, STATE, ZIP
TELEPHONE
CUSTOMER NUMBER
A SIGNATURE IS REQUIRED IN ORDER TO PROCESS THE APPLICATION
As applicant, I
, certify or declare under penalty of perjury under the laws of the State of Washington
that the foregoing is true and correct. All information given is subject to verification with State of Washington, Department of Revenue.
SIGNATURE
DATE
PLEASE PRINT your NAME
TITLE
FOR OFFICE USE ONLY
Select appropriate fee based on estimated Seattle TAXABLE revenue:
$55.00
Taxable revenue will be LESS than $20,000
Processed by
$110.00
Taxable revenue will be $20,000 to $499,999
$480.00
Taxable revenue will be $500,000 to $1,999,999
$1,000.00
Taxable revenue will be $2,000,000 or greater
Tax Forms Mailed
For start date prior to 2017: calculate fees at $110 for the years 2015 and 2016 ($55 if
Enforcement
gross less than $20,000); $90 for years prior ($45 if gross less than $20,000)
IMPORTANT!
If start date is July 1 or later: Pay only half of the first year's fee
License # Issued
$
Additional Seattle Locations
X $10.00 =
TOTAL DUE
$
...................................................................................
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