Form Boe-400-Mco - Application For Seller'S Permit And Registration As A Retailer (Corporations/limited Liability Company/organizations) - 2003
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1
2BOE-400-MCO (FRONT) REV. 12 (1-03)
STATE OF CALIFORNIA
APPLICATION FOR SELLER’S PERMIT AND REGISTRATION
BOARD OF EQUALIZATION
AS A RETAILER (CORPORATIONS/LIMITED LIABILITY COMPANY/ORGANIZATIONS)
Use additional sheets to include information for more than three individuals.
SECTION I: OWNERSHIP INFORMATION
FOR BOARD USE ONLY
1. PLEASE CHECK TYPE OF OWNERSHIP
TAX
IND
OFFICE
NUMBER
Corporation
Limited Liability Company (LLC)
S
Unincorporated Business Trust
BUSINESS CODE
AREA CODE
Other
(describe)
Enter Federal Employer Identification Number (FEIN), if any
APPLICATION PROCESSED BY
VERIFICATION:
DL
Other
2. ENTER FULL NAME OF CORPORATION, LIMITED LIABILITY CO. (LLC), OR UNINCORPORATED BUSINESS TRUST
3. CORPORATE, OR LLC NUMBER/STATE OF INCORPORATION OR ORGANIZATION
4. STATE OF INCORPORATION OR ORGANIZATION
LLC or Corporate Officer
LLC Manager
LLC Member
Trustee
Beneficiary
CHECK ONE
5.
FULL NAME
(first, middle, last)
6. TITLE
7. SOCIAL SECURITY NUMBER (corporate officers excluded)
8. DRIVER LICENSE NUMBER (attach verification)
9. RESIDENCE ADDRESS (street, city, state, zip code)
10. RESIDENCE TELEPHONE NUMBER
(
)
LLC or Corporate Officer
LLC Manager
LLC Member
Trustee
Beneficiary
CHECK ONE
(first, middle, last)
11.
FULL NAME
12. TITLE
13. SOCIAL SECURITY NUMBER (corporate officers excluded)
14. DRIVER LICENSE NUMBER (attach verification)
15. RESIDENCE ADDRESS (street, city, state, zip code)
16. RESIDENCE TELEPHONE NUMBER
(
)
LLC or Corporate Officer
LLC Manager
LLC Member
Trustee
Beneficiary
CHECK ONE
17.
FULL NAME
(first, middle, last)
18. TITLE
19. SOCIAL SECURITY NUMBER (corporate officers excluded)
20. DRIVER LICENSE NUMBER (attach verification)
21. RESIDENCE ADDRESS (street, city, state, zip code)
22. RESIDENCE TELEPHONE NUMBER
(
)
SECTION II: BUSINESS INFORMATION
23. BUSINESS NAME [DBA] (if any)
24. BUSINESS ADDRESS (street, city, state, zip code) [do not list P.O. Box or mailing service]
25. BUSINESS TELEPHONE NUMBER
(
)
26. MAILING ADDRESS (street, city, state, zip code) [if different from business address]
27. BUSINESS FAX NUMBER
(
)
28. DATE YOU WILL BEGIN BUSINESS ACTIVITIES (month, day and year)
29. TYPE OF ITEMS SOLD
30. NUMBER OF SELLING LOCATIONS
(if 2 or more, attach list of all locations)
31. TYPE OF BUSINESS (check one that best describes your business)
check one
Retail
Wholesale
Mfg.
Repair
Service
Construction Contractor
Full Time
Part Time
32. OWNERSHIP CHANGES
Are you buying an existing business?
Yes
No
If yes, complete items 33 through 37.
Are you changing from one type of business organization to another (for example, from a sole owner to a corporation or from a
partnership to a limited liability company, etc.)?
Yes
No
If yes, complete items 35 and 36 on the back of this form.
Other:
33. PURCHASE PRICE
34. VALUE OF FIXTURES & EQUIPMENT
$
$
Continued on Reverse
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