ApplicAtion for
business tAx license
DAviDson county clerk
Date________________
Receipt #_____________
Business #____________
ALL QUESTIONS MUST BE ANSWERED COMPLETELY. INCOMPLETE AND UNSIGNED APPLICATIONS WILL DELAY PROCESSING.
FOR ASSISTANCE, PLEASE CONTACT THIS OFFICE AT (615) 862-6254.
1. FOR OFFICE USE ONLY:
_______ CLASSIFICATION 1A _______ CLASSIFICATION 1C _______ CLASSIFICATION 2 _______ CLASSIFICATION 4
_______ CLASSIFICATION 1B _______ CLASSIFICATION 1D _______ CLASSIFICATION 3
2. REASON FOR APPLYING:
1. New Business 2. Additional Location 3. Purchase of Existing Business
9. ENTER FEDERAL EMPLOYER’S IDENTIFICATION #
10. CURRENT SALES TAX NUMBER FOR THIS BUSINESS LOCATION
11. TYPE OF OWNERSHIP (SELECT ONE):
PROPRIETORSHIP HUSBAND/WIFE OWNERSHIP OTHER
PARTNERSHIP CORPORATION LIMITED LIABILITY COMPANY
13. DESCRIBE THE BUSINESS ACTIVITY AT THIS LOCATION, STATING THE MAJOR PRODUCTS AND/OR SERVICES SOLD:
14. IDENTIFY OFFICERS, PARTNERS, OR INDIVIDUAL OR COMPANY OWNERS
15. THE STATEMENTS MADE ON THIS APPLICATION ARE TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF. (THIS APPLICATION
MUST BE SIGNED BY THE INDIVIDUAL OWNER, A PARTNER, OR AN OFFICER OF THE CORPORATION AND INCLUDE PHOTOCOPY OF
DRIVER’S LICENSE. THE SIGNATORY MUST ALSO BE LISTED IN ITEM 14.)
SIGN
HERE:__________________________________________________________________________ ________________________________________
SIGNATURE of OWNER, PARTNER, or OFFICER (DO NOT PRINT OR USE STAMP) TITLE DATE
Make remittance check payable to “Davidson County Clerk.” VISIT US AT: Davidson County Clerk
523 Mainstream Drive, Nashville, TN 37228
Please call (615) 862-6254 with questions. MAIL TO: Davidson County Clerk
P.O. Box 196333, Nashville, TN 37219-6333
This application must be received within 20 days from commencement of business or penalty and interest will apply.
7. BUSINESS TELEPHONE NUMBER
( ) _____________________
BUSINESS FAX NUMBER
( ) _____________________
6. COUNTY IN WHICH BUSINESS IS LOCATED
__________________________________
County License Fee $15.00
IS BUSINESS LOCATED INSIDE A TENNESSEE CITY LIMIT?
NO YES ____________________________________
(If yes, write Name of City and add City License Fee $15.00
TOTAL__________
8. CONTACT PERSON’S NAME
___________________________
CONTACT E-MAIL ADDRESS
___________________________
12. TENNESSEE SECRETARY OF STATE
IDENTIFICATION #, IF APPLICABLE
__________________________________
BUSINESS NAME
_______________________________________________________________________
STREET, HIGHWAY (DO NOT USE P
.
O. BOX NUMBER OR RURAL ROUTE NUMBER)
_______________________________________________________________________
CITY
ST
AT
E ZIP
C
ODE
NAME (ENTER LEGAL NAME, IF DIFFERENT)
_______________________________________________________________________
P.
O. BOX, STREET, ROUTE, OR HIGHWAY
_______________________________________________________________________
CITY
ST
AT
E ZIP
C
ODE
4. BUSINESS NAME AND EXACT LOCATION 5. BUSINESS MAILING ADDRESS
3. DATE BUSINESS BEGAN IN TENNESSEE AT THIS
LOCATION:
________________________________
APPLIED FOR
NOT REQUIRED
APPLIED FOR
NOT REQUIRED
(1) NAME HOME TELEPHONE # SOCIAL SECURITY # FEDERAL EIN
HOME ADDRESS (DO NOT USE P.O. BOX #) CITY STATE ZIP CODE
Member Ofcer Partner Owner - Individual Owner - Company
(2) NAME HOME TELEPHONE # SOCIAL SECURITY # FEDERAL EIN
HOME ADDRESS (DO NOT USE P.O. BOX #) CITY STATE ZIP CODE
Member Ofcer Partner Owner - Individual Owner - Company
