Business Tax Identification Application - City Of Daphne

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CITY OF DAPHNE, ALABAMA BUSINESS TAX IDENTIFICATION APPLICATION
(CONFIDENTIAL)
Applicant Complete This Box
Complete and Mail
FedID#_____________________________
ST of Ala Tax #______________________
City of DAPHNE
TAXPAYER ID#_____________
Form of Ownership (Check One)
P.O. Drawer 1047
Sole Proprietor
Partnership
DAPHNE, AL 36526
Corporation
Professional Assoc.
Please Print or Type
LLC
Other ____________
Phone: (251) 621-6613 Fax: (251)621-6904
SEE REVERSE SIDE FOR INSTRUCTIONS
AND FURTHER INFORMATION
Date Business Activity Initiated/Proposed in DAPHNE: _________________________DATE OF APPLICATION:_________________________
APPLICATION TYPE:
NEW
RENEWAL
OWNER CHANGE
NAME CHANGE
LOCATION CHANGE
Legal Business Name:
_____________________________________________________________________________________________
Trade Name: (If different from above)______________________________________________________________________
Anticipated Gross Revenue from start date through December 31st: $_____________________________________________
Deliveries via common carrier (ONLY):
YES
NO
Physical presence in Daphne (i.e. Sales/Service):
YES
NO
Business Activities: (Brief desc. - example. retail clothing sales, wholesale food sales, rental of industrial equip., carpentry contractor, etc.)
_________________________________________________________________________________________________________________
Physical Address: __________________________________________________________________________________________________
(Street)
(City)
(State)
(Zip)
Mailing Address: __________________________________________________________________________________________________
(Street)
(City)
(State)
(Zip)
Telephone: _______________________________________________________________________________________________________
( Business)
(Cell)
(Home)
(Fax)
Email:
List Names of Owner(s), Partners, or Officers (Attach separate sheet if necessary)
Name
Driver License #/State
SSN
Title
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
This application has been examined by me and is, to the best of my knowledge, a true and complete representation of the above named entity,
and person(s) listed.
Date __________________ Signature ______________________________________________
Title ____________________________
THIS AREA FOR MUNICIPAL USE ONLY
DATE: ________________PAID:_________________CHECK/CASH_________________BY:_______________BATCH#_____________
Physical Location:
Tax Types:
TAX FILING FREQUENCY:
BUSINESS TYPE:
CITY/COMMERCIAL (001)
SALES/SELLER'S USE
ANNUAL
RETAIL
CITY/RESIDENTIAL (003)
CONSUMER USE
QUARTERLY
WHOLESALE
PJ (N/A)
RENTAL
MONTHLY
BUILDING CONTRACTOR
BALDWIN CO (010)
LODGINGS
OTHER______________
___________________
MOBILE CO (008)
LOCAL LIQUOR
SERVICE
ALABAMA (999)
BEER/WINE
PROFESSIONAL
OUT OF STATE (009)
TOBACCO
MANUFACTURER
GAS/MOTOR FUEL
RENTAL
NAICS CODE
____________________
APPROVAL (BIN) COMPLETE:
YES
NO
____________________
APPLICATION FOR HOME BUSINESS COMPLETE:
YES
NO
____________________

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