SalesTax Application Form PDF_REV_9_04.p65

Sales/Use Tax license
FINANCE DEPARTMENT
SALES TAX DIVISION
911 10th St.
application
Golden, CO 80401
Fee $20.00
Certificates will not be issued unless this form is filled out entirely.
Questions regarding Application
Phone: (303) 384-8024 · Fax: (303) 384-8001
Please mark all that apply.
Business information
q New Business in Golden
Business Name q Home-Based Business
Physical Address City State Business Phone: (
)
Zip Business Fax: (
)
issuance of your tax
license does not imply
compliance with all
city departments or
other jurisdictions
Business Web Address: Business Email: mailing information
Mailing Address City Reporting Frequency:
q Monthly
State Zip q *Quarterly
q *Annually
* Please note, you may only file annually if you have no retail sales and are only providing a service, and quarterly if tax is less than $60.00 monthly.
Have you remitted tax to us in the past? If so, please note when: Taxpayer representative Name
Phone Number
Location of Records: City State Zip New Business Type of Ownership: (check one)
q Sole Proprietorship
q Partnership
q Corporation
q Non-Profit Corporation (No Fee, Attach Proof)
q Other, Please Explain owner / officer information
Owner/President Drivers Licence # (attach copy)
Vice President Drivers Licence # (attach copy)
Date you started / Will open business Description of business (please detail types of service(s) / product(s) and nature of business Is your business physically located in the City of Golden?
q Yes
q No
If yes, complete page 2.
I declare, under penalty of perjury, that this application has been examined by me and the statements made herein are made in good faith pursuant
to the City of Golden tax laws and ordinances and, to the best of my knowledge and beliefs, are true, correct and complete.
Print or type name Title Authorized Signature Title for city use only
Account # STF Application 10/08
Entered Date if your business is physically located in golden - complete the following
business information
Normal Business Hours Do you report hazardous materials under EPCRA or 112R? q Yes
q No
What is the location of your onsite Hazmat Inventory List? What is the location of your onsite Hazmat Storage Plan? What is the location of your onsite Material Safety Data Sheet? Building Square Footage Do you have an alarm system?
Business Square Footage q Yes
q No
Fire Alarm Monitoring Company Phone # Acct # Fire Alarm Service Company Phone # Acct # Burglar Alarm Company Phone # Acct # Burglar Alarm Service Company Phone # Acct # Are you a home based business?
For Home Based Businesses - Number of Employees, including yourself If you provide Daycare, # of Children owner / officer information
Owner/President Home Phone # Home Address City Vice President Home Phone # Home Address City Secretary Home Phone # Home Address City Treasurer Home Phone # Home Address City Cell # State Zip Cell # State Zip Cell # State Zip Cell # State Zip Name of Previous Business Owner Name of Previous Business local emergency contacts (List a minimum of 3 in the order you want them called by dispatch)
Name Home Phone # Home Address Name City Home Phone # Home Address Name City Home Phone # Home Address City Page 2
Cell # State Zip Cell # State Zip Cell # State Zip LAWFUL PRESENCE AFFIDAVIT
I, _____________________________________, swear or affirm under penalty of perjury
under the laws of the State of Colorado that (check one):
□
I am a United States citizen; or
□
I am a Permanent Resident of the United States; or
□
I am lawfully present in the United States pursuant to Federal law.
I understand that this sworn statement is required by law because I have applied for a
public benefit. I understand that state law requires me to provide proof that I am lawfully
present in the United States prior to receipt of this public benefit. I further acknowledge
that making a false, fictitious, or fraudulent statement or representation in this sworn
affidavit is punishable under the criminal laws of Colorado as perjury in the second
degree under Colorado Revised Statute 18-8-503 and it shall constitute a separate
criminal offense each time a public benefit is fraudulently received.
_________________________________
Signature
________________________
Date