License Application Form For Transaction Privilege (Sales) Tax Business, Occupational And Professional (Bop)

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LICENSE APPLICATION
CITY OF GLENDALE
Office Location:
TRANSACTION PRIVILEGE (SALES) TAX
Telephone - (623) 930-3190
5850 W. Glendale Ave
Fax - (623) 930-2186
BUSINESS, OCCUPATIONAL AND
Glendale, AZ 85301-2599
PROFESSIONAL (BOP)
! Sales Tax
! BOP
Check one:
! New Business
Former Owner (if applicable)
Previous City License No.
Check one:
! New Owner of Existing Business
! Name Change Only
Check any
Current City License No.
Date of Change
! Location Change
that apply:
SECTION I. BUSINESS INFORMATION
FOR OFFICE USE ONLY
App. Fee
Business Name (Individual, Company or "DBA", first name first)
License Fee
Street No.
(N,E,S,W)
Street Name
Type
Ste/Apt No.
-
-
License No.
City
State
ZIP Code + 4
Area Code
Business Telephone No.
Start Date
E-mail Address or Fax No.
-
SIC Code
State License No.
Federal ID No.
SECTION II. MAILING ADDRESS & PHONE NUMBER
Business Class
Enter Name if Different from Section I (above) or Enter 'In-Care-Of' Name
Geo Code
Street No.
(N,E,S,W)
Street Name
Type
Ste/Apt No.
Filing Freq.
-
City
State
ZIP Code
Area Code
Telephone No.
Initials
SECTION III. BUSINESS OWNERSHIP & RECORD LOCATION
Ownership: ! Individual
! LLC
! Corp. - State Inc.______
! Gen. Partnership
! Ltd. Partnership
! Other ____________
Zoning
1)
Name
Title
Approved
Owners, Partners,
LLC Members,
Home Address
Social Security No.
Denied
or Officers
(For Additional Names,
City
State
ZIP Code
Phone No.
Please Attach List)
Comments
(
)
2)
Name
Title
Home Address
Social Security No.
City
State
ZIP Code
Phone No.
(
)
Corporate or LLC
Name
Phone No.
(
)
Statutory Agent
Name
Phone No.
Location Where
(
)
Business Records
Address
City
State
ZIP Code
Are Kept
Section IV. Business Type
! Retail Sales ! Advertising ! Amusement ! Construction Contracting ! Use Tax ! Restaurant/Bar ! Hotel/Motel
Business Type
! Lease/Rent-Real Property
! Lease/Rent-Personal Prop.
! Telecommunication
! Other_____________________
Describe Nature of
Contractors No.
Business
! Cash Receipts
! Accrual
No. of Employees
Check method you will use in submitting reports:
Section V. Business Premises Status
! Yes ! No
! Yes ! No
Do you own your business location?
If yes, Is this your residence?
Check one:
If no, complete Landlord/Property Manager information
Landlord/Property Manager Name
Address
Phone No.
(
)
! Yes
! No
Do you rent a portion of the business premises to another entity?
I certify that the statements made in this application are true and complete to the best of my knowledge. I accept the license authorized and issued in
response to this application with the condition that I report timely and pay any and all taxes due by me to the city. Incomplete forms may not be processed.
IF APPLICABLE, BE SURE ALL SALES TAX HAS BEEN PAID BY FORMER OWNER. BY LAW YOU MAY BE LIABLE FOR ANY UNPAID TAX.
Print Name
Signature
Title
Date
WEB
License App. Rev. 10/2000

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