Form Reg - Registration Form For New Businesses, Tax Entity Changes & Reopening Businesses - City Of Portland - 2017

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REGISTRATION FORM
New businesses, tax entity changes & reopening businesses
CITY OF PORTLAND BUSINESS LICENSE TAX
& MULTNOMAH COUNTY BUSINESS INCOME TAX
MAIL or FAX completed form to: 111 SW COLUMBIA, SUITE 600, PORTLAND OR 97201
FAX: 503-823-5192 ~ Register online & learn about the program:
Office: 503-823-5157 ~ TDD: 503-823-6868
Most information is subject to disclosure under Public Record Law.
GENERAL BUSINESS INFORMATION
CHECK & COMPLETE ALL THAT APPLY
BUSINESS ACTIVITY
EXISTING ACCOUNTS: TAX ENTITY
BUSINESS ACTIVITY CONDUCTED
BUSINESS ACTIVITY CONDUCTED
ALSO OCCURS OUTSIDE
CHANGE OR SOLE PROPRIETOR
IN THE CITY OF PORTLAND
IN MULTNOMAH COUNTY
MULTNOMAH COUNTY
REOPENING A BUSINESS
/ CITY OF PORTLAND
PORTLAND BUSINESS START DATE:
MULT. CO. BUSINESS START DATE:
BUSINESS TAX ACCT #:
YES
NO
LAST NAME, FIRST NAME (Corporations, Partnerships, LPs, LLPs, S-Corps, and multiple-member LLCs: enter business name)
DOING BUSINESS AS (If different from above. Include single-member LLC business name here. State of OR: “Assumed Business Name”)
BUSINESS ACTIVITY DESCRIPTION
BUSINESS FAX
BUSINESS/CONTACT EMAIL ADDRESS
BUSINESS PHONE
CONTACT NAME
CONTACT FAX
CONTACT PHONE
BUSINESS TAX ENTITY TYPE (Select one)
ADDITIONAL BUSINESS TAX INFORMATION
Limited Partnership
Corporation
Sole Proprietor (single-member LLCs)
Business is a Non-profit Corporation under IRS Sec 501
Limited Liability Partnership
Trust
(Attach Federal 501c3 Certification Letter)
Limited Liability Company (mult mem)
S-Corporation
Business is a Joint Venture / Tenant-in-Common
Partnership
Estate
BUSINESS FISCAL/TAX YEAR END (Sole Props: December) *SOCIAL SEC # (Sole Props) *FEDERAL EMPLOYER ID # (EIN) # OF OWNERS
12 - December
PRIMARY BUSINESS LOCATION
(Include additional business locations and/or addresses of rental property on the back of this form)
PRIMARY BUSINESS LOCATION ADDRESS (No PMBs or PO Boxes)
STATE/
ZIP/POSTAL CODE
CITY
OR
BUSINESS PROPERTY TYPE (select all that apply):
COMMERCIAL
RESIDENTIAL
RENTAL PROPERTY OWNED, # OF UNITS: ______________
MAILING ADDRESS
MAILING ADDRESS (PMB or PO Boxes accepted)
same as above
STATE/PROV ZIP/POSTAL CODE
CITY
OR
OWNERS AND/OR PARTNERS
Businesses with stockholders: List corporate owners that hold more than 5% of the voting stock of the corporation.
List all partners, including limited partners (if any) and all LLC members. Use additional sheets if needed.
OWNER/PARTNER NAME AND ADDRESS
*SSN # OR EIN #
% OF STOCK/OWNERSHIP
0.00%
0.00%
0.00%
0.00%
* Social Security # and Federal Employer ID # (EIN)
FORM REG (Rev 4/26/2017)
CONTINUED
are not subject to public disclosure.
(this is a 2-page form)

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