Form 211 - Business Registration Application
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1Tax Administration Division
Form 211
Business Registration Application
(Print or Type in Black Ink only)
*Indicates a required field
*Taxpayer Name: ________________________________________________________________________________________________________________
(Company Name or DBA)
*Mailing Address: __________________________________________________ ________________________________ _______ _________________
Address
City
State
Zip Code
*Principle Business Location: ______________________________________ _________________________________ _______ _______________
Address
City
State
Zip Code
*Primary Business Telephone Number: (_____) ______ - ________
Fax: (_____) ______ - ________
*Business Email/Website (If applicable): ___________________________________________________________________________________
*Primary Contact: _______________________________________ (____) _____ - _______ ________________________________________________
Name
Telephone Number
Email Address
*Contractor’s License No. (If applicable): __________________________________________
*NMTRD CRS ID No.: ______________________________________________
Corporation
Limited Liability Company (LLC)
Individual/SoleProprietorship
*Type of Ownership (check one)
Government
Non Profit Organization (
:_______________)
Partnership (
Type
Type:______________)
Tribal Member Owned Business (Tribe: _________________________________)
Other: __________________________
Name: ______________________________________________________________ Name: ____________________________________________________________________
*List Owners, Partners, Corporate Officers (Attach additional pages as needed)
Title: _______________________________________________________________ Title: _______________________________________________________________________
Phone: (_____) _______ - ___________
Phone: (_____) _______ - ___________
Email: ______________________________________________________________ Email: _____________________________________________________________________
Tribal ID No. (if applicable) ______________________________ Tribal ID No. (if applicable) ____________________________________
Cash
Accrual
*Method of Accounting
*Give a brief description of the type of business you will conduct within the Pueblo of Laguna: __________________
_____________________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________________
*I attest that the information provided within this application and any supplemental
documentation attached to this application is true and correct.
________________________________________________________________________________
_________________________________________________
Print Name
Title
_______________________________________________________________________________
_____ / _____ / _______
Signature
Date
_______________________________________________________________________
_____ / _____ / _______
TAD Director
Date
P.O. Box 194 Laguna, NM 87026
(505) 552-6654
info.tax@lagunapueblo-nsn.gov
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Parent category: Life