Fillable APPLICATION FOR MASTER LICENSE (The Tulalip Tribes)

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APPLICATION FOR MASTER LICENSE (The Tulalip Tribes)

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The APPLICATION FOR MASTER LICENSE (The Tulalip Tribes) form is 3 pages long and contains:

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  • 102 check-boxes
  • 240 other fields

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File type: PDF

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NEW - Home Business (Arts and crafts businesses and artists with two or less employees)
$50.00
Change in Organizational Structure/Business type
NAME CHANGE
PENALTIES - type: _________________________ Amt: $___________
Additional background check fee per employee to engage in peddling activity in Tulalip
$90.00
$40.00
$ 5.00
$25.00
$15.00
RENEWAL - NO CHANGES
LIC #
OFFICIAL USE ONLY
OTHER LIC #
APPLICABLE YEAR
CHECK/MONEY ORDER #
RECEIPT NUMBER
TULALIP TAX & LICENSING DIVISION
6406 Marine DR NW - Tulalip, WA 98271
Office: 360.716.4216 - Fax: 360.716.0180
TLD@TULALIPTRIBES-NSN.GOV
I/D RVW REQ'D:
N/A FWD APP TO:
DENIED CAUSE:
APPROVED WITH CONDITIONS
APPLICATION FOR MASTER LICENSE
INCOMPLETE AND ILLEGIBLE APPLICATIONS WILL BE RETURNED TO APPLICANT MINUS ANY FEE PAID.
ALL LICENSES EXPIRE DECEMBER 31 OF EACH YEAR.
A
PAYMENTS Applications received without payment in full will not be accepted. Enclose total amount due. Accepted forms of payment are cash, check, and money
order made payable to Tulalip TLD. Credit card payment accepted in person only to Cashier window - if renewing, please have license number(s) ready. License fees
are not pro-rated and are nonrefundable. New businesses with physical location in Tulalip: Contact TLD for preapplication review prior to remitting payment ensure
business location is appropriately zoned and other requisites are met.
Legal Business Name
Business Address (Physical Location to be licensed)
City
State
Zip
Agent Mailing Address (Do Not use PO Box)
Direct license-related queries, correspondence, and other documents to:
Registered Agent Name (Corporations and LLCs)
Other:
BUSINESS INFORMATION - GENERAL
Mailing and physical address are the same
DBA I (Alternate Legal Name, or registered Trade Name)
DBA II (Alternate Legal Name, or registered Trade Name)
Check all names to appear on license and select order number of appearance:
Legal Business Name
Primary Contact listed above
DBA I
DBA II
1st
2nd
3rd
State/Tribe of registry
State/Tribe of registry
City
State
Zip
Website:
WWW.
Business Mailing Address (If Different From Above)
Primary Contact Title
Preferred Method of Contact:
RA Company Name
Email Address
Alt Phone
Fax
Phone
Preferred Method of Contact:
Email Address
Phys Loc Contact Name
Alt Phone
Fax
Phone
Phys Loc Contact Title
FaxPhone Email
Mail
Preferred Method of Contact:
Email Address
Alt Phone
Fax
Phone
City
State
Zip
Registered AgentMailing Contact listed above
B
PAYMENT AND FEES
Primary Contact Person or Department (If Different From Above)
Change of Ownership
Change of LocationNew Business
WITH CHANGES (other than location, ownership, structure, or location)
RENEWAL - Peddler (1)
$75.00
NEW - Peddler (1)
FEES
* DO NOT list if name is not registered with WA Secretary of state or equivalent
* DO NOT list if name is not registered with WA Secretary of state or equivalent
1st 2nd 3rd 1st 2nd 3rd
FaxPhone Email
Mail
FaxPhone Email
Mail
WA State Unified Business Identification Number (WA UBI #) Federal Employer I.D. Number (FEIN) North American Industry Classification System # (NAICS)
Reseller’s Permit Number Contractor’s License Number Union Name
LICENSURE / REGISTERED TRADE NAMES ("DBAs")
Provide names of all INACTIVE Tulalip licenses held by business, including any licenses p
_
reviously held by business partners, managers, members, and/or affiliates. Indicate business name,
license number, start/end year, and purpose of dissolution:
Provide names of all ACTIVE Tulalip licenses held by business, including licenses held by business partners, managers, members, and/or affiliates. Indicate business name, license number,
business type, and owner(s):
LIC # BUSINESS NAME BUSINESS TYPE OWNER(S)
LIC # BUSINESS NAME YEARS LIC ACTIVE PURPOSE OF DISSOLUTION:
TO
TO
TO
C
2019 Master Business App 1 of 3updated 01.2019
( ) -
( ) -
( ) -
( ) - ( ) -
( ) -
( ) -
( ) - (
-
)
2019 Master Business App 2 of 3updated 01.2019
FORMATION, IDENTIFICATION OF OWNERS, ORGANIZATIONAL STRUCTURE
Does business possess status /classification as a non-profit organization (ex: 501 C-3) registered with the WA Secretary of State?
If yes, attach proof of status and select your organizational status type below.
State(s) or Tribe(s)
of Incorporation:
Number of Corporate Officers,
Governing Members, or Partners:
SELECT ENTITY TYPE /
FORMATION STRUCTURE
NON-PROFITS SKIP TO
NEXT QUESTION
NON-PROFIT / NOT FOR
PROFIT, EDUCATIONAL,
CHARITABLE, AND
RELIGIOUS
ORGANIZATIONS
NO
YES
/
MM DD Y Y
(Date business intends to begin or first began operating at the location and ownership listed in Section A)
Name (Last, First, Middle)
Title
Direct Telephone Number
( ) -
Personal Address (Street or Route, P.O. BOX, City, State, Zip)
% Owned
Other
Owner
D
PARTNERS, OFFICERS, MANAGERS, MEMBERS, DIRECTORS List all owners, partners, officers, members, governing members, managers and directors. Inidicate if
individual corporate officers, partners, or managers are also directors, members, and/or shareholders. Attach separate sheet(s) if necessary.
CHARITABLE ORGANIZATION
CHARITABLE TRUST
RELIGIOUS ORGANIZATION NOT FOR
PROFIT CORPORATION
SOLE PROPRIETOR
FOREIGN CORPORATION
LIMITED LIABILITY COMPANY
INDIVIDUAL - NO EMPLOYEES
PARTNERSHIP
FOR PROFIT FUNDRAISER
DOMESTIC CORPORATION
EDUCATIONAL ORGANIZATION
OTHER:
Date of Formation
Date of Incorporation
Does business sell public
or
p
rivate shares?
Private
/
/ /
Public
N/A
Are any Partners, Managers, or Corporate Officers in WA also Directors, Members and/or Shareholders? If yes, and different from the names you will provide below,
attach separate list with the first and last name, title, and # of shares or % owned.
NO
OTHER:
LIMITED LIABILTY PARTNERSHIP
Name (Last, First, Middle)
Title
Direct Telephone Number
Personal Address (Street or Route, P.O. BOX, City, State, Zip)
% Owned
Other
Owner
Name (Last, First, Middle)
Title
Direct Telephone Number
Personal Address (Street or Route, P.O. BOX, City, State, Zip)
% Owned
Other
Owner
Name (Last, First, Middle)
Title
Direct Telephone Number
Personal Address (Street or Route, P.O. BOX, City, State, Zip)
% Owned
Other
Owner
Provide a detailed description of the nature of business, principle products sold, and /or services provided on the Tulalip Reservation.
NO
Are products manufactured on the reservation?
If yes, explain the process and equipment used in production. Attach additional sheets if necessary:
On-site customers:
NO
Is business affiliated with any other business(es), including subsidiaries? If yes, explain. Attach additional sheets if necessary:
Previous year Gross Annual Income derived from sales of products
and/or services occurring within exterior boundaries of Tulalip:
N/A - New Business License
No income derived from Tulalip sales or service for prior year
Wholesale salesRetail sales
Services only - no tangible products
Services
Check all that apply:
Online sales Personal delivery
Product shipped to consumer
Businesses operating from an home office or residential structure in Tulalip please provide estimated number of:
NATURE OF BUSINESS - PRODUCT AND SERVICE
YES
E
YES
YES
Is this a franchise?
NO
$
YES
*TUIJTZPVSQSJmary place of residence?
NO
NO
YES
Does/Will Business maintain and office or store within Tulalip?
YES
Is office or store located within a residential structire (Ie "Home Office")? If yes:
NO
Employees:
Traffic - Average Daily
Trips: Resident employees:
OWN LEASE/RENT
OWN LEASE/RENT
LEASES WITH THE TULALIP TRIBES: Consent from authorized official required. Contact TLD for assistance.
ALL OTHER LEASES/RENTALS: Attach a notarized letter of consent from landlord authorizing applicant to use leased property for business purpose. Letter must include
business type/activity, lease expiration date, landlord and lessee legal names, and landlord contact information.
If residential location is not at your primary residence, please explain:
Does applicant lease/rent or own the land at the location of proposed business to be licensed?
Does applicant lease/rent or own the structure(s) at the location of proposed business to be licensed?
On-site Deliveries:
Nonresident employees:
Off Street Parking spaces:
Square feet used for business :
MM DD Y Y
LEASES WITH QCV: One of the following:
Proof of Special Operators License or
Recent food service survey (if applicable)
Copy of lease agreement with QCV and
TULALIP LOCAL & HOME BUSINESSES/OCCUPATIONS
LAND USE, ZONING, LEASES, AND RESIDENTIAL OFFICES (TTC TTC 6.05 - Housing, 6.15 - Leases, TTC 7 - Land Use)
Businesses operated from a residence or accessory building may be subject to other laws enforced by various government departments, including the Housing, Real Estate & Asset, and
Planning Departments. Permits and other forms of authorization may be required. The TLD provides all applications for business license to the Planning Dept for review. Applications are
provided to other appropriate departments for review based upon the data collected in the application process and other information known about the proposed activity. For more
information, please contact the TLD and we will connect you to the appropriate officials.

All permanent and temporary businesses and vendors seeking to provide services or conduct business operations within the Consolidated Borough of Quil Ceda Villlage (QCV) are required
to enter into an agreement with the QCV Business Park. Food Permits for temporary establishments may also be obtained through QCV. For more information please call 360.716.5000.
If yes to either lease/rent question above, please attach:
( ) -
( ) -
( ) -
YES
2019 Master Business App 3 of 3updated 01.2019
Does primary business activity include one or more persons traveling from place to place by foot or vehicle to offer and/or solicit sales or service ?
If yes, refer to Peddler's license in TTC 10.10 and attach the following to your application:
Do your business dealings and transactions include providing care or services (non-retail) children under the age of 18?
If yes, please explain:
NO YES
NO YES
E
NATURE OF BUSINESS - PRODUCT AND SERVICE - Cont'd
Copy of a valid WA State Drivers License for each person operating vehicle / mobile unit in Tulalip
Photo(s) of all vehicles/mobile units used to provide services on the reservation and a brief description including make, model, year, license plate number, color, any affixed signage,
advertisement, or other identifying marker.
Do your business operations include manufacturing, distribution, or retail or wholesale sale of alcoholic products?
Do your products or services include wholesale or retail sales of fireworks or fireworks display shows?
If yes, attach a description of services, a product list, price sheet, proof of state/federal approvals, and provide class of fireworks: ________________
YES
NO
Do your business operations include manufacturing, distribution, or retail or wholesale sale of tobacco products?
YESNO
Will you prepare food or beverage goods for consumer consumption?
FIREWORKS (TTC10.25), ALCOHOL (TTC10.35), FOOD AND BEVERAGE (TTC 11.20), AND TOBACCO (TTC 12.10)
Chapter 10.25 - Fireworks: Retail sales of 1.4G fireworks is restricted to enrolled members of the Tulalip Tribes; wholesale sales of 1.4G fireworks are not restricted
to membership. Other classes of fireworks are prohibited and not eligible for licensure.
Chapter 10.35 - Liquor Licenses and Tulalip Liquor Regulations: INSPECTION REQUIRED - Retail sale of spirits, liquor by the drink, banquet licenses, and various
endorsements.
Chapter 10.40 - Transient Accommodations: INSPECTION REQUIRED - Hotel, motel, and other public overnight accommodations.
Chapter 11.20 - Food Service Sanitation: INSPECTION REQUIRED - All temporary, full time, and part time food service establishments serving Tulalip
Chapter 12.10 - Cigarette Tax: License and tax applies to retail sales of tobacco products.
INSPECTIONS: Contact the TLD to schedule 360.716.4216
Tribal owned businesses located in Tulalip are subject to TTC 12.05 - Sales and Use Tax and TTC 12.25 - Restaurant Privilege Tax
YESNO
YESNO
CONTRACTORS, TRIBAL BUSINESSES, TERO & NAOB REGISTRY
TULALIP TRIBAL EMPLOYMENT RIGHTS OFFICE
Tulalip Employment Rights Office (TERO) is the Equal Employment Opportunity Commission (EEOC) representative for Tulalip. TERO laws enforce specific
hiring and labor requirements upon businesses, contractors, and subcontractors doing business within the exterior boundaries of Tulalip, including
regulation of employment practices and obligating employers to provide preference in recruiting, hiring, training and promoting qualified Native
Americans. Visit www.tulaliptero.com or call 360.716.4747 for more information. (TTC 09.05)
%
If yes, attach proof of tribal enrollment for each owner/shareholder, their title, and their individual percentage percentage of ownership.
Are any owners or shareholders enrolled in a federall recognized tribe?
If yes, total percentage owned by enrolled member(s):
YESNO
Does business have a Tulalip TERO Compliance Contract
?
Is business listed on the Native Owned Business Registry?
INSURED
BONDED
EXPIRATION DATE BOND AMOUNT
$
INS. AMOUNT
EFFECTIVE DATE
EXPIRATION DATE
$
EFFECTIVE DATE
ACCT #
COMPANY NAME
POLICY #
COMPANY NAME
INS. AMOUNT
EXPIRATION DATE
$
EFFECTIVE DATE
POLICY #
COMPANY NAME
Check all that apply, provide additional information for each checked box. Is this business:
CONTRACTOR
SUBCONTRACTOR
NONE OF THESE
TYPEPROJECT LOCATION PERMIT No.
SCOPE OF WORK
CONTRACTOR NAME
PROJECT MANAGER NAME
TRIBAL DEPARTMENT OVERSEEING PROJECT PHONE
TRIBAL PROJECT
( ) -
START DATE
If no, do you intend to enter into a TERO Compliance Contract?
If no, would you like information how your NAOB can benefit from this free resource?
YESNO
YESNO
Does this business possess valid vendors license issued by a Tribal Gaming Agency
?
NO YES
If yes, attach proof of VL and provide number: VL
Are your business activities in Tulalip limited to service at one or more of the three (3) licensed Tulalip gaming establishments?
If yes, are your goods or services non-gaming in nature? If yes, describe:
NO YES
NO YES
Do you supply less than $25,000 in goods or services in Tulalip annually?
If yes, to any of the above, your VL may qualify your business to waive master license requirements. Please contact our office for more information at 360.716.4211.
Is your business activity in Tulalip limited to accounting or legal services or supplying only food, beverage, gift shop, advertising, promotional, entertainment or
marketing goods and services?
NO YES
NO YES
GAMING AND VENDORS OF GAMING VENUES
GAMING - ALL CLASSES (TTC 10.05)
TGA: Businesses providing services at or one or more of the Casino or Bingo establishments in Tulalip, and vendors of gaming products (lotto, games of
chance, etc.) must obtain a gaming vendor license issued by the Tribal Gaming Agency (TGA). For more information, contact the Tulalip TGA Office at 360.716.2000
INDIAN TRADERS LICENSE For information pertaining to Indian Trader’s Licenses, please visit/ contact the Bureau of Indian Affairs, Puget Sound Agency at:
2707 Colby Avenue, Suite #1101, Everett, WA 98201 - (425) 258-2651
NO YES
BY SIGNING BELOW, I UNDERSTAND AND AGREE TO THE FOLLOWING:
I DECLARE THAT I HAVE EXAMINED THIS APPLICATION AND THE INFORMATION CONTAINED HEREIN, AND TO THE BEST OF MY KNOWLEDGE AND BELIEF, IT IS TRUE
AND CORRECT. I SWEAR OR AFFIRM
THAT I WILL COMPLY WITH ALL TRIBAL LAWS APPLICABLE TO MY BUSINESS AND CONSENT TO THE JURISDICTION OF THE TRIBAL
COURT OF THE TULALIP TRIBES AND SERVICE OF PROCESS IN MATTERS ARISING FROM THE CONDUCT OF BUSINESS.
Signature
X
Printed Name Title Date
Signature
X
Printed Name
Title
Date
Application prepared
by
(Indicate
if
prepared
by other
than
authorized owner, officer,
manager,
or member)
Signature of Preparer
X
Title D
ate
Telephone Number
( )
-
SIGNATURE REQUIRED
Signature attests to the accuracy of the information provided and that business will comply with all applicable Tribal and Local Laws
F
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APPLICATION FOR MASTER LICENSE (The Tulalip Tribes)

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Completed 20 July 2020

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