Form Genreg - Registration/application For Permit Page 2

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11. Partnership, LLC, LLP,
_________________________________________________________________________________
S Corporation or C
President or Partner
Corporation
-
-
(
)
-
Social Security Number
Phone
_________________________________________________________________________________
Secretary or Partner
-
-
(
)
-
Social Security Number
Phone
_________________________________________________________________________________
Treasurer or Partner
-
-
(
)
-
Social Security Number
Phone
12. Purchased an Existing
_________________________________________________________________________________
Business
Previous Business Name
M M
/
D D
/
Y Y Y Y
Date Acquired
_________________________________________________________________________________
Previous Owner(s)
13. Lodging Facility Tax
_________________________________________________________________________
and Rental Vehicle
Doing Business As (DBA) Name
Tax only
List each location
_________________________________________________________________________________
separately
DBA Business Address (physical location)
___________________
_____________________________
_________
_______________
City
State
Zip Code
County
__________________________________________________________
_____________________
Contact Person
Phone
_________________________________________________________________________________
Nature of Business
 Yes
 No
Are you a seasonal business?
___________________________________________
If yes, what months are you in operation?
 Yes
 No
Is this facility within city limits?

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