Fillable 20 BUSINESS / SALES TAX LICENSE APPLICATION (Town of Wellington)

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20 BUSINESS / SALES TAX LICENSE APPLICATION (Town of Wellington)

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The 20 BUSINESS / SALES TAX LICENSE APPLICATION (Town of Wellington) form is 4 pages long and contains:

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  • 57 check-boxes
  • 117 other fields

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20 BUSINESS / SALES TAX LICENSE APPLICATION
For General Business or Retail Sales Tax
Business may n
ot be conducted until a Business / Sales Tax License has been issued.
Please allow 3 to 7 days for processing and approval of completed form. Must supply a copy of Driver's License
Inspections May Be Required: It is your responsibility to contact Wellington Fire Protection
District (970-568-3232) and Building Department
(970-568-3554) to determine if an
inspection is required. This must be done before your license can be approved.
Bus
iness
I
nform
a
t
i
on
IF
YOUR
BUSINESS
IS
LOCATED
WITHIN
TOWN
LIMITS,
THIS
INFORMATION
WILL
BE
LISTED
ON
THE
TOWN
WEBSITE
BUSINESS
DIRECTORY
TYPE OF APPLICATION:
Change of Location Change of Ownership New Application Renewal
BUSINESS NAME TRADE NAME (Doing Business As)
TAXPAYER NAME (Owner(s), Partner(s), or Corporation name)
BUSINESS LOCATION ADDRESS (No P.O. Box)
CITY
STATE
ZIP
MAILING ADDRESS CITY STATE ZIP
BUSINESS PHONE BUSINESS WEBSITE BUSINESS E-MAIL
CONTACT NAME/TITLE
CONTACT E-MAIL
Gene
r
al
Bus
iness
I
nform
a
t
i
on
TYPE OF BUSINESS (Check all that
apply)
Communications / Telecom
Construction
Finance/Leasing/Banking
Insurance / Real Estate
Internet
Professional
Restaurant
Retail
Service
Technical / Scientific
Manufacturing
Wholesale
Office Only
Home Occupation
SPECIFY ITEMS SOLD AND/OR SERVICES PERFORMED:
THIS BUSINESS:
Is in a private Wellington residence that is owned by applicant (Home Occupation Registration is required – see Page 3)
Is in a private Wellington
residence and is leased by applicant (Home Occupation Registration & Landlord Statement are required – see Page 3)
Is in a commercial building
Has no physical location in Wellington
SQ. FT OF WELLINGTON LOCATION
NUMBER OF EMPLOYEES (include self)
Full time Part time
NUMBER OF FLOORS
Locations
DO YOU HAVE OTHER LOCATIONS IN WELLINGTON? No
Yes If “Yes”, a separate application must be completed for each business location WMC Sec. 6-2-40
YEARS AT CURRENT LOCATION PREVIOUS LOCATION (CITY, STATE & ZIP)
O
th
e
r
DO YOU CHARGE YOUR CUSTOMER SALES TAX? No
Yes If “Yes”, completion of page 2 is Mandatory per WMC Sec. 6-2-110.
WILL
Y
O
U
BE SELLING,
O
R RESELLING,
O
R DISTRIBUTING,
O
R
DELIVERING
AN
Y TANGIBLE PROPERTY IN THE TOWN OF WELLINGTON?
No Skip Financial Information section on page 2 complete remainder of form.
Yes Sales Tax License is Required. Complete page 2 (Mandatory per WMC Sec. 6-2-110), and pages 3 and 4 if applicable.
S
igna
tur
e
I declare under penalty of perjury, that this application has been examined by me; that the statements made herein are made in good faith and, to the
best of my knowledge and belief, are true, correct and complete. I understand that while this document is not public record by itself, non-confidential
items are public record. All confidential items on this application are noted as being confidential. Furthermore, I understand that any business and
tax license issued by the Town does not allow me to conduct or maintain any business, occupation or activity prohibited by statute or ordinance.
APPLICANT’S SIGNATURE
PRINTED NAME
DATE
Attn: License Application ∙ 3735 Cleveland Ave.∙ Wellington, Colorado ∙ 80549 ∙ ph: 970-568-3381 ∙ www.wellingtoncolorado.gov
Date Received
Amount Paid
Check Number
Date Issued
License Number
Mobile Vendor
Contractors must provide a copy of liabiliaty insurance
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signature
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BUSINESS / SALES TAX LICENSE APPLICATION
2
PAGE 2 OF 4
Filing Information
FILING FREQUENCY OF SALES TAX:
IF BUSINESS IS SEASONAL, CHECK EACH MONTH OPEN FOR BUSINESS:
Monthly (if tax is more than $300 per month)
Quarterly
Annually
(if tax is less than $300 per month)
(if tax is less than $100 per month)
Feb
Mar Apr
May
June
July
Sep
Oct Nov
Dec
STATE OF COLORADO SALES TAX NUMBER (For all retail & exempt businesses)
Ownership Information
TYPE OF OWNERSHIP
Sole Proprietor
Partnership LLC (Requires copy of proof of I.D. and Affidavit of Lawful Presence - See Page 4)
CORPORATION Non-Profit 501(c)(3) Other Non-Profit
COMPLETE THE FOLLOWING FOR EACH OWNER, PARTNER, MEMBER, OR OFFICER: (Use additional sheet if necessary)
1) NAME TITLE HOME PHONE SOCIAL SECURITY NUMBER
HOME ADDRESS CITY STATE ZIP
2) NAME TITLE HOME PHONE
SOCIAL SECURITY NUMBER
HOME ADDRESS CITY STATE ZIP
3) NAME TITLE HOME PHONE SOCIAL SECURITY NUMBER
HOME ADDRESS
CITY
STATE ZIP
Fire Department
Information
After Hours Emergency Contact List
Contact Name and Title:
CONFIDENTIAL
All information provided in this section of the application is required for a Retail Sales Tax License. This information is considered confidential and will not be publically released.
Aug
Jan
Other
Home Phone:
Cell Phone:
Contact Name and Title:
Contact Name and Title:
Home Phone:
Home Phone:
Cell Phone:
Cell Phone:
Are there any hazardous materials (covered by the most currently adopted fire code) stored or sold at this location?
Yes
No
Jurisdiction Code
Day Care
Provider
Number of Children Licesed to Care for
Date of inspection by County Health Department
___________________
Date of inspection by Wellington Fire Department
___________________
Attach copy of State license
____________________
3
BUSINESS / SALES TAX LICENSE APPLICATION
Page 3 of 4
IF THE BUSINESS IS IN A PRIVATE WELLINGTON RESIDENCE, A HOME OCCUPATION REGISTRATION MUST BE COMPLETED.
Hom
e
Occupation Registration
BRIEF DESCRIPTION OF THE BUSINESS YOU ARE CONDUCTING IN YOUR HOME:
WILL CUSTOMERS OR CLIENTS BE CONDUCTING BUSINESS ENTIRELY WITHIN THE DWELLING OUTSIDE THE HOURS OF 6:00AM AND
9:00PM?
NOTE: CHILD CARE IS EXEMPT FROM THIS REGULATION (PLEASE SEND A COPY OF YOUR STATE LICENSE).
Yes
No
WILL THE TO THE MAIN USE OF THE DWELLING BE SECONDARY TO THE BUSINESS?
Yes
No
WILL THERE BE SALES OF STOCKS, SUPPLIES OR PRODUCTS CONDUCTED ON THE PREMISES?
No
DOES THS SPACE FOR THE BUSINESS EXCEED ONE-HALF (1/2) THE FLOOR AREA OF THE DWELLING UNIT?
Yes
No
WILL THERE BE ANY EXTERIOR STORAGE ON THE PREMISES OF MATERIAL OR EQUIPMENT USED AS A PART OF THE HOME OCCUPATION?
Yes No
DO YOU HAVE LESS THAN (2) OFF-STREET PARKING SPACES ADEQUATE TO ACCOMMODATE ALL NEEDS CREATED BY THE
HOME OCCUPATION
Yes
No
WILL THERE BE ANY EXTERIOR ADVERTISING OTHER THAN IDENTIFICATION OF THE HOME OCCUPATION? Residential signs -
Wall signs or freestanding signs shall be no
larger than 4 sq. feet)
Yes No
No
IF YOU ANSWERED “YES” TO ANY OF THE ABOVE QUESTIONS THEN YOU DO NOT COMPLY WITH THE HOME OCCUPATION CRITERIA OF WMC SECTION 16-12-10
AND MAY NOT CONDUCT THIS BUSINESS FROM YOUR HOME.
If granted, I/We the undersigned, agree to comply with the Town of Wellington Municipal Code Section 16-12-10 and any other
stipulations as determined
by the Planning Department. I/We hereby depose and state under penalties of perjury that all statements
submitted within this application are true and correct to the best of my knowledge.
APPLICANT’S SIGNATURE
DATE
IF THE BUSINESS IS IN A PRIVATE WELLINGTON RESIDENCE AND IS LEASED, A LANDLORD STATEMENT MUST BE COMPLETED.
Landlord Statement
PROPERTY ADDRESS
TENANT NAME
PROPOSED BUSINESS NAME
I declare, under
penalty of perjury in the second degree, that this application has been examined by me and I am the owner of record at the physical
address of this application. The proposed business owner named on this application is my tenant. I have read the application and am aware of the
nature of business being conducted on my property. I give permission for this applicant, my tenant, to conduct this business on my property
within all the laws, regulations, and requirements of the Town of Wellington.
SIGNATURE / PROPERTY OWNER OF RECORD
DATE
PRINTED NAME / PROPERTY OWNER OF RECORD
PHONE NUMBER
The following are requirements for a home occupation in a residential district.
Name __________________________________________________________
Physical Address _________________________________________________
Phone number ________________________
Email Address ________________________________
Zoning District __________________
Yes
Yes
DO YOU HAVE ONE (1) OR MORE EMPLOYEE WHO IS NOT LIVING IN YOUR HOME?
WILL THERE BE ANY OFFENSIVE NOISE, VIBRATION, SMOKE, DUST, ODORS, HEAT OR GLARE NOTICEABLE AT OR BEYOND THE
PROPERTY LINE?
Yes No
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BUSINESS / SALES TAX LICENSE APPLICATION
4
PAGE 4 OF 4
L
aw
fu
l
Pr
esence
of Aff
i
d
avi
t
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 legal Permanent Resident of the United States, or
I am otherwise lawfully present in the United States pursuant to Federal law.
Per HB 06S-1023, you must provide a copy of one of the following IDs (please check which one is attached:
Colorado Driver’s License
Colorado ID card
Military IDs
Coast Guard mariner document
Native American tribal document
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.
APPLICANT’S SIGNATURE
DATE
Office Use Only
Zoning
Fire Department
Sheriff's Department
DATE
Yes
Yes
Yes
Yes
Approved
Administration
Comment:
No
Comment:
Comment:
Comment:
Approved
Approved
Approved
No
No
No
DATE
DATE
DATE
To Submit application save to desktop or print form. Send to Cynthia Sullivan at
sullivcj@wellingtoncolorado.gov or Town of Wellington P.O. Box 127 Wellington, CO 80549
Submit Document:
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20 BUSINESS SALES TAX LICENSE APPLICATION (Town of Wellington)

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Completed 17 July 2020

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