Form Boe-400-Mco - Application For Seller'S Permit And Registration As A Retailer - (Corporations/limited Liability Company/organizations)

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BOE-400-MCO (S2F) REV. 8 (12-97)
STATE OF CALIFORNIA
APPLICATION FOR SELLER’S PERMIT AND REGISTRATION AS A RETAILER
BOARD OF EQUALIZATION
(CORPORATIONS/LIMITED LIABILITY COMPANY/ORGANIZATIONS)
SECTION I: OWNERSHIP INFORMATION
FOR BOARD USE ONLY
1. PLEASE CHECK TYPE OF OWNERSHIP
TAX
OFFICE
NUMBER
Photocopy of
S
Driver's License and
Corporation
Limited Liability Company (LLC)
Social Security Card
BUSINESS CODE
AREA CODE
Unincorporated Business Trust
is required
Other _________________________________
See instruction number 6
PREPARER
VERIFICATION:
SSN
DL
Other
2. IF CORPORATION, ENTER FULL CORPORATE NAME. IF LIMITED LIABILITY CO. (LLC), ENTER FULL LLC NAME. IF ORGANIZATION, ENTER FULL ORGANIZATION NAME
3. FEDERAL EMPLOYER IDENTIFICATION NUMBER (FEIN)
4. CORPORATE OR LLC NUMBER/STATE OF INCORPORATION OR ORGANIZATION
Please check appropriate title and use additional sheet to include information about additional co-owners or members.
President
Manager
Member
Vice-Pres.
Manager
Member
Treasurer
Manager
Member
Secretary
Manager
Member
Trustee
Beneficiary
Trustee
Beneficiary
Trustee
Beneficiary
Trustee
Beneficiary
5. FULL NAME
(incl. mid.name)
6. ADDRESS
(residence)
7. TELEPHONE
(
)
(
)
(
)
(
)
(residence)
8. DAYTIME
(
)
(
)
(
)
(
)
TELEPHONE
9. SOCIAL
SECURITY NO.
10. DRIVER’S
LICENSE NO.
11. SIGNATURE
SECTION II: BUSINESS INFORMATION
BUSINESS TELEPHONE
1. BUSINESS NAME
(
)
2. BUSINESS ADDRESS (DO NOT LIST P.O. BOX OR MAILING SERVICE)
CITY
STATE
ZIP CODE
3. MAILING ADDRESS (IF DIFFERENT FROM NO. 2 ABOVE)
CITY
STATE
ZIP CODE
DAYS & HOURS OF
4. DATE YOU WILL BEGIN SALES (month, day, & year)
Mon.
Tue.
Wed.
Thurs.
Fri.
Sat.
Sun.
OPERATION
5. DESCRIPTION OF BUSINESS
A. WHAT WILL YOU SELL?
B. CHECK THE APPROPRIATE BOX
C. CHECK THE APPROPRIATE BOX
Retail
Wholesale
Manufacturing
Repair
Full-time
Part-time
Mail-order
Service
Construction Contractor
D. ARE YOU
Starting a new business?
Adding/dropping partner?
Incorporating?
Buying a business?
Other?
IF BUYING A BUSINESS, PLEASE INDICATE NAME AND ACCOUNT NO. OF FORMER OWNER
VALUE OF FIXTURES AND EQUIPMENT
E. PURCHASE PRICE
$
$
6. IF AN ESCROW COMPANY IS REQUESTING A TAX CLEARANCE ON YOUR BEHALF, PLEASE LIST THEIR NAME, ADDRESS, TELEPHONE NUMBER AND THE ESCROW NUMBER
7. HOW MANY SELLING LOCATIONS WILL YOU HAVE? (IF 2 OR MORE ATTACH LIST OF ALL LOCATIONS)
8. IF ALCOHOLIC BEVERAGES ARE SOLD, PLEASE LIST YOUR ALCOHOLIC BEVERAGE CONTROL LICENSE NO. AND TYPE:
Continued on Reverse

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