Form 523 - Application For Tax Certificate
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1
2COMPLETE AND RETURN THIS FORM TO:
TAXPAYER IDENTIFICATION NUMBER
CITY OF BIRMINGHAM – REVENUE DIVISION
(City Office Use Only)
710 NORTH 20th STREET – ROOM TL 100
BIRMINGHAM, ALABAMA 35203
CITY OF BIRMINGHAM, ALABAMA
PHONE (205) 254-2198
FAX (205) 254-2963
APPLICATION FOR TAX CERTIFICATE
THE INFORMATION THAT YOU PROVIDE IN THIS APPLICATION IS SUBJECT TO THE CONFIDENTIALITY PROVISIONS OUTLINED IN ARTICLE II, SECTION 14 OF ORDINANCE NO. 97-183,
“THE BUSINESS LICENSE CODE OF THE CITY OF BIRMINGHAM.” PLEASE PRINT OR TYPE. APPLICATION SHOULD BE COMPLETED FULLY TO AVOID DELAYS IN PROCESSING.
TRADE NAME AND MAILING ADDRESS TO WHICH TAX FORMS ARE TO BE SENT: (IF A POST
TRADE NAME AND ADDRESS LOCATION OF OFFICE IN BIRMINGHAM–IMPORTANT NOTE: ALL
OFFICE BOX, A STREET ADDRESS MUST ALSO BE SHOWN. (IF BUSINESS IS A CORPORATION,
BUSINESS LOCATIONS SUBJECT TO ZONING APPROVAL.
IF YOUR BUSINESS LOCATION IS IN A
RESIDENTIAL AREA, YOU MUST MAKE APPLICATION IN PERSON AT THE ADDRESS SHOWN ABOVE.
LLC, OR LLP A COPY OF ARTICLES OF CORPORATION OR ORGANIZATION MUST ACCOMPANY
THIS APPLICATION.)
IF YOU HAVE MORE THAN ONE TAXABLE LOCATION, PLEASE LIST ON THE REVERSE SIDE OF THIS FORM.
CITY
STATE
ZIP
CITY
STATE
ZIP
-
-
PHONE NUMBER OF APPLICANT: AREA CODE
PHONE NUMBER OF LOCATION: AREA CODE
-
-
FAX NUMBER: AREA CODE
FAX NUMBER: AREA CODE
EMAIL OR WEBSITE ADDRESS:
EMAIL OR WEBSITE ADDRESS:
NAME OF LOCAL CONTACT PERSON:
NAME OF CONTACT PERSON:
IF THIS APPLICATION IS BEING MADE AS A RESULT OF A CHANGE IN OWNERSHIP, MERGER, OR ACQUISITION OF AN EXSITING BUSINESS, YOU MUST COMPLETE THIS SECTION.
PLEASE INDICATE THE NAME, ADDRESS, AND CITY OF BIRMINGHAM TAXPAYER IDENTIFICATION NUMBER BELOW.
FORMER OWNER________________________________________________________________________________________ BIRMINGHAM TAXPAYER ID NUMBER__________________________________
DBA (DOING BUSINESS AS)__________________________________________________________________________________________________________________________________________________
MAILING ADDRESS OF FORMER OWNER______________________________________________________________________________________________________________________________________
PHONE NUMBER OF FORMER OWNER________________________________________________________________________________________________________________________________________
FORM OF ORGANIZATION:
TYPE OF BUSINESS:
1. MANUFACTURER
2. CONTRACTOR
1. CORPORATION
2. PARTNERSHIP
3. WHOLESALER
4. RETAILER
3. PROPRIETORSHIP
4. PROFESSIONAL ASSOCIATION
5. OTHER
5. OTHER
DATE BUSINESS BEGAN IN BIRMINGHAM:
DATE TAX NUMBER APPLIED FOR:
MONTH
DATE
YEAR
MONTH
DATE
YEAR
FEDERAL I.D. TAX NUMBER (REQUIRED):
NUMBER OF EMPLOYEES IN BIRMINGHAM:
PRINCIPAL BUSINESS ACTIVITY AND PRODUCT. (SEE INSTRUCTIONS ON REVERSE SIDE).
ACTIVITY
PRODUCT
CHECK THE TAXES FOR WHICH YOU ARE LIABLE:
TAX IDENTIFICATION NUMBERS NOW ASSIGNED TO YOU:
(WRITE “NONE” IF NO NUMBER ASSIGNED)
Sales Tax
State of Alabama Sales Tax Number
Sellers Use Tax
Consumer Use Tax
State of Alabama Sellers Use Tax Number
Lease Tax
State of Alabama Consumers Use Tax Number
Occupational Tax–Employer
State of Alabama Lease Tax Number
Occupational Tax–Individual
Business License Tax
State of Alabama Unemployment Tax Number
If you have more than one business location, it is assumed that you will file consolidated returns for each of these taxes: Sales, Use, Leasing, and Occupational.
For the Business License Tax, you must have a separate license for each location.
CORPORATE OFFICERS, PARTNERS, OR OWNER (ATTACH ADDITIONAL SHEETS IF NECESSARY)
TITLE
SOCIAL SECURITY NUMBER
NAME
I HEREBY CERTIFY THAT ALL INFORMATION AND STATEMENTS HEREIN ARE TRUE AND CORRECT:
SIGNATURE OF PERSON COMPLETING THIS APPLICATION
PRINT THE NAME OF THE PERSON COMPLETING THIS APPLICATION
PHONE NUMBER OF PERSON COMPLETING THIS APPLICATION
DATE
CITY OFFICE USE ONLY
SIC/NAICS ______________________________ BLIC______________________________ TERR ______________________________ ANNEX ______________________________ ZONING ____________________________________
NOTES:____________________________________________________________________________________________________________________________________________________________________________________________
#523 FIN. 9-01
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