5
BOE-400-MIP (FRONT) REV. 14 (5-00)
STATE OF CALIFORNIA
APPLICATION FOR SELLER'S PERMIT AND REGISTRATION
BOARD OF EQUALIZATION
AS A RETAILER (INDIVIDUALS/PARTNERS)
Use additional sheet(s) to include information for more than two partners
SECTION I: OWNERSHIP INFORMATION
FOR BOARD USE ONLY
1. PLEASE CHECK TYPE OF OWNERSHIP
TAX
IND
OFFICE
NUMBER
Sole Owner
Husband/Wife Co-ownership
SR
Partnership
BUSINESS CODE
AREA CODE
Enter Federal Employer Identification Number (FEIN), if any
APPLICATION PROCESSED BY
VERIFICATION:
SSN
DL
Other
OWNER OR PARTNER
2. FULL NAME (first, middle, last)
3. SOCIAL SECURITY NUMBER (attach verification)
4. DRIVER’S LICENSE NUMBER (attach verification)
5. RESIDENCE ADDRESS (street, city, state, zip code)
6. RESIDENCE TELEPHONE NUMBER
(
)
7. NAME, ADDRESS & TELEPHONE NUMBER OF A PERSONAL REFERENCE
CO-OWNER OR PARTNER
8. FULL NAME (first, middle, last)
9. SOCIAL SECURITY NUMBER (attach verification)
10. DRIVER’S LICENSE NUMBER (attach verification)
11. RESIDENCE ADDRESS (street, city, state, zip code)
12. RESIDENCE TELEPHONE NUMBER
(
)
13. NAME, ADDRESS & TELEPHONE NUMBER OF A PERSONAL REFERENCE
SECTION II: BUSINESS INFORMATION
14. BUSINESS NAME [DBA] (if any)
15. PARTNERSHIP NAME (if any)
16. BUSINESS ADDRESS (street, city, state, zip code) [do not list P.O. Box or mailing service]
17. BUSINESS TELEPHONE NUMBER
(
)
18. MAILING ADDRESS (street, city, state, zip code) [if different from business address]
19. DATE YOU WILL BEGIN SALES (month, day & year)
20. TYPE OF ITEMS SOLD
21. NUMBER OF SELLING LOCATIONS
(if 2 or more, attach list of all locations)
22. TYPE OF BUSINESS (check one)
CHECK ONE
Retail
Wholesale
Mfg.
Repair
Service
Construction Contractor
Full Time
Part Time
23. OWNERSHIP CHANGES
Are you buying a business?
Yes
No If yes, complete items 24 through 28 below.
Are you adding/dropping a partner?
Yes
No If yes, complete item 27 below.
Other:
24. PURCHASE PRICE
25. VALUE OF FIXTURES & EQUIPMENT
$
$
26. FORMER OWNER’S NAME
27. SELLER’S PERMIT ACCOUNT NUMBER
28. IF AN ESCROW COMPANY IS REQUESTING A TAX CLEARANCE ON YOUR BEHALF, PLEASE LIST THEIR NAME, ADDRESS, TELEPHONE NUMBER AND THE ESCROW NUMBER
29. DO YOU MAKE INTERNET SALES?
30. WEBSITE ADDRESS
Yes
No If yes, answer 30.
Application for Seller’s Permit n Individuals/Partners (5-00)