Business Registration Application Form
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1
2
3CITY OF BATON ROUGE
For Office Use Only
PARISH OF EAST BATON ROUGE
For Office Use Only
Account Number
P.O. BOX 2590
Application Number
BATON ROUGE, LA 70821
PHONE: (225) 389-3084
____________________
____________________
FAX: (225) 389-5369
Email:
Revised 12/30/2013
Louisiana Tax Number
Federal ID Number
Description of Business
NAIC Number
(See List of Business Classes attached)
LEGAL NAME OF BUSINESS
TRADE NAME OF BUSINESS
PHYSICAL LOCATION
(NOT a P.O. Box)
Business Telephone No. (
)
-
MAILING ADDRESS
APPLICATION FOR:
DATE IN BUSINESS:
/
/
BUSINESS LOCATION:
Sales Tax Registration
City Limits of Baton Rouge
Occupational License Tax
Unincorporated Parish of EBR
Hotel Motel Tax
City Limits of Baker
Insurance Premium Tax
City Limits of Central
Gross Receipts Tax
City Limits of Zachary
Other _________________
Business Located Outside of EBR
REASON FOR APPLYING:
New Business
Purchased Existing Business?
Previous Owner:
Merger
Trade Name of Previous Owner/Business:
Additional Information
Previous Account Number:
Change / Other
If checked, Home Based Business Signature form attached and signed
Home Based Business
FOR OCCUPATIONAL LICENSE ONLY
FOR OFFICE USE ONLY
Enter as PAY
Hotel / Nursing Home / Rooms
(# of rooms) x $2 per room =
$
Enter as DIR
Security Deposit Due?
Yes
No
Deposit Due:
$
If business opened less than 30 days ago:
MIN (no I&P)
Business opened on or prior to June 30 of current year (Minimum Payment $50) OR
$
MIN (no I&P)
Business opened on or after July 1 of current year (Minimum Payment $25) OR
$
Enter as PAY
Flat Fee Business
$100 / $200 / $250
$
If business opened more than 30 days ago (Tax Due for First Year of Business):
Enter as PAY
st
Enter Gross Receipts (1
30 days in business)
$
Less Allowable Deductions
$
Tax Basis (Gross Receipts less Deductions)
$
Multiply Tax Basis by # of months in business*
$
*(Any month open at least 15 days)
Tax Due (Based on applicable Tax Table)
$
ABC Account
Penalty
$
*99999999*
Interest
$
Clearance Issued
Total Due
$
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