APPLICATION FOR OCCUPATIONAL LICENSE
ST. TAMMANY PARISH TAX COLLECTOR
P. O. Box 1229
Slidell, La. 70459 985-726-7790
FAX 985-726-7794
PLEASE PRINT WHEN COMPLETING THIS FORM
Classification of Business: (Service, Retail, Contractor, Etc.)
( ) If this is a new business, check the block and enter the opening date:
Date
Occupational license tax fee for new business is $50.00 / becomes $25.00 on July 1
st
of application year.
Total paid: Check Number or Cash
1. Business Name, Address, and Phone
Business Name:
Mailing Address
City State Zip Code
Business Phone:
2. Location of Your Business: ( please do not use your P. O. Box as your location)
Street Address:
City/State/Zip:
3. Sole Proprietor
Owners Name:
Last Middle Initial First
Mailing Address:
City/State/Zip:
Phone Number: Social Security Number:
4. Corporations and Limited Partnerships (For incorporated and limited partnerships only. If incorporated, attach a copy of your State
Charter Certificate, please list all officers of corporation.)
OFFICERS;
1. Name: Title: SSN:
Address: Home Phone:
2. Name: Title: SSN:
Address: Home Phone:
3. Name: Title: SSN:
Address: Home Phone:
4. Name: Title: SSN:
Address: Home Phone:
Description of activity of business: _________________________________________________________________
I certify to the best of my knowledge, the above information is true and correct.
Signature of Owner, Agent, Officer Title Date
For Office Use Only
Account Number Check Number Date Paid
click to sign
signature
click to edit
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