Form Boe-400-Mip (S2f) - Application For Seller'S Permit And Registration As A Retailer (Individuals/partners)

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BOE-400-MIP (S2F) REV. 11 (5-97)
STATE OF CALIFORNIA
APPLICATION FOR SELLER'S PERMIT AND REGISTRATION
BOARD OF EQUALIZATION
AS A RETAILER (INDIVIDUALS/PARTNERS)
SECTION I: OWNERSHIP INFORMATION
FOR BOARD USE ONLY
(use additional sheet to include information about additional
1. PLEASE CHECK TYPE OF OWNERSHIP
TAX
OFFICE
NUMBER
co-owners or partners)
Photocopy of
S
Sole Owner
Husband/Wife Co-ownership
Driver's License and
BUSINESS CODE
AREA CODE
Social Security Card
Partnership (If partnership enter Federal
is required
Employer Indentification Number (FEIN) numbers)
PREPARER
VERIFICATION:
See instruction number 6
SSN
DL
Other
OWNER OR PARTNER
CO-OWNER OR PARTNER
2. FULL NAME
(first, middle, last)
3. RESIDENCE ADDRESS
(enter full address
including zip code)
4. RESIDENCE
(
)
(
)
TELEPHONE NO.
5. SOCIAL SECURITY NO.
6. DRIVER’S LICENSE NO.
& DATE OF BIRTH
7. PRESENT/PAST
EMPLOYER
(enter full address including
zip code & telephone no.)
8. NAME, ADDRESS &
1.
1.
TELEPHONE NO. OF
TWO PERSONAL
2.
2.
REFERENCES
9. SPOUSE’S NAME
10. SPOUSE’S SOCIAL
SECURITY NO.
11. SPOUSE’S DRIVER’S
LICENSE NO. & DATE
OF BIRTH
12. SIGNATURE
SECTION II: BUSINESS INFORMATION
1. BUSINESS NAME
BUSINESS TELEPHONE
(
)
(do not list P.O. Box or mailing service)
2. BUSINESS ADDRESS
CITY
STATE
ZIP CODE
(if different from No. 2 above)
3. MAILING ADDRESS
CITY
STATE
ZIP CODE
(month, day & year)
4. DATE YOU WILL BEGIN SALES
5. DAYS & HOURS
SUNDAY
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
OF OPERATION
(check one)
6. TYPE OF BUSINESS
CHECK ONE
Retail
Wholesale
Mfg.
Repair
Service
Construction Contractor
Full Time
Part Time
Mail Order
7. TYPE OF ITEMS SOLD
8. ARE YOU
FORMER OWNER’S NAME
Starting a new business?
Adding/dropping partner?
Other? _____________
ACCOUNT NUMBER
Buying a business? (indicate name & account number in area at right)
(if 2 or more attach list of all locations)
9. PURCHASE PRICE
10. VALUE OF FIXTURES & EQUIPMENT
11. NUMBER OF SELLING LOCATIONS
$
$
12. IF AN ESCROW COMPANY IS REQUESTING A TAX CLEARANCE ON YOUR BEHALF, PLEASE LIST THEIR NAME, ADDRESS, TELEPHONE NUMBER AND THE ESCROW NUMBER
13. IF ALCOHOLIC BEVERAGES ARE SOLD, PLEASE LIST YOUR ALCOHOLIC BEVERAGE CONTROL LICENSE NO. AND TYPE

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