Form 49-52d - Application For Transaction Privilege (Sales) And Use Tax License - 2001

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City of Phoenix
SEE FEE
FINANCE DEPARTMENT
APPLICATION FOR TRANSACTION
SCHEDULE
Tele: (602) 262-6785,
PRIVILEGE (SALES) AND USE TAX LICENSE
press 4, 1
ON PG. 3
TDD: (602) 534-5500
OFFICE
Master No.
Permanent
Check one:
USE
BLS Ref.
Temporary
Check one:
New Business
Former Owner (if applicable)
Previous City License #
OFFICE USE
New Owner of Existing Business
ONLY
Check any
Name Change Only
Current City License #
Date of Change
Activity / SIC Code
that apply:
Location Change
/
SECTION I. BUSINESS INFORMATION
/
Business Name (Individual, Company or “DBA”, first name first):
/
Location Address
(actual street address of the rental property, retail store, restaurant, etc. NOT A P.O. BOX NUMBER or postal mail box):
/
City, State, Country, ZIP Code + 4:
Business Phone (Including Area Code):
/
/
Start Date:
E-mail address:
State License #:
Federal ID #:
/
SECTION II. MAILING ADDRESS & PHONE NUMBER
License Category
S
C
M
O
Enter Name if Different from Section I (above) or Enter Care-of Name:
Previous License #
Mailing Address:
Rental Units
City, State, Country, ZIP Code + 4:
Phone (Including Area Code):
Owner Type
SECTION III. BUSINESS OWNERSHIP & RECORD LOCATION
Billing Cycle
Ownership:
Individual
LLC
Corp. - State Inc. _______
Gen. Partnership
Ltd. Partnership
Other __________
M
Q
A
Name
Title
Owners, Partners. LLC
1)
Begin Date
Members, or Officers
(For Additional Names, Please
Social Security #
Home Address
Report Method
Attach List or Supplemental
C
A
Information Form)
Phone No.
City
State
ZIP Code
Liability Date
(
)
Name
Title
Inspector Code
2)
Entered by
Social Security #
Home Address
Approved by
Phone No.
City
State
ZIP Code
(
)
Name
Counter
Mail
Phone No.
Corporate or LLC
Statutory Agent
(
)
Name
Phone No.
Location Where Business
(
)
Records Are Kept
State
ZIP Code
Address
City
SECTION IV. BUSINESS TYPE
Retail Sales
Restaurant/Bar
Amusement
Construction Contracting
Use Tax
Wholesaler
Business Type
Manufacturer
Commercial Rental
Residential Rental (# of Units _______)
Hotel/Motel
Other ____________
Contractors #
Describe Nature of
Business
Check method you will use in submitting reports:
Cash Receipts
Accrual
# of Employees
SECTION V. BUSINESS PREMISES STATUS
Do you own your business location?
Yes
No
If yes, is this your residence?
Yes
No
Check one:
If no, complete Landlord/Property Manager information
Phone No.
Landlord/Property Manager Name
Address
(
)
Do you rent a portion of the business premises to another entity?
Yes
No
I certify that the statements made in this application are true and complete to the best of my knowledge. I
accept the permit authorized and issued in response to this application with the condition that I report
OFFICE USE
timely and pay any and all taxes due by me to the City of Phoenix. 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
Title
ONLY
Signature
Date
49-52D Rev. 01/01

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