APPLICATION FOR TAX/LICENSE ACCOUNT
CITY OF DEMOPOLIS
211 NORTH WALNUT
Phone: (334) 289-0577 DEMOPOLIS, AL 36732 Fax: (334) 289-8051
Read and complete this application. Provide any required documentation to the clerk or compliance officer.
Municipal Taxpayer ID# ________________
Date of Application: _______________________________
NEW APPLICATION CHANGE OF OWNERSHIP CHANGE OF PHYSICAL LOCATION NAME CHANGE ONLY
CHECK TYPE OF OWNERSHIP:
Corporation
Partnership
Sole Proprietor
Professional Association
Other (Type:________________________)
CHECK PRIMARY BUSINESS TYPE:
Manufacturer
Wholesaler
Contractor
Retailer
Other
TAXPAYER’S LEGAL NAME & MAILING ADDRESS:
Name__________________________________________________
Street _________________________________________________
City
__________________________ ST_______ Zip____________
Social Security Number or FEIN:_________________________
Phone Number ______________________________________
Fax Number ______________________________________
D.B.A. (If Different Trade Name From Above) _______________________________________________________________________________
Date Business Activity Initiated or Proposed in Demopolis _______________________________________________________________________
Brief Description of Business Activity _______________________________________________________________________________________
Product (If Applicable) ___________________________________________________________________________________________________
Does this company have salespeople soliciting in Demopolis? ______yes ______no
Does this company deliver into Demopolis in its’ own vehicles? ______yes ______no
Does this company purchase taxable materials from outside the Demopolis jurisdiction? ______yes ______no
Street Address of Location Being Licensed ___________________________________________________________________________________
Local Phone ________________________________________________ E-Mail Address: _________________________________________
TYPE OF TAX COLLECTIONS
Check Applicable Taxes for this Business in The City of Demopolis Business License/Tax Jurisdiction:
Liquor Tax
Business License
Lodging Tax
Sales and/or Amusement Tax
Franchise Tax Consumers Use Tax Sellers Use Tax
Gasoline Tax Tobacco Tax Rental Tax
Information and/or documentation required: Drivers License or other picture identification (Visa, Passport, and Employment Authorization Card); State License
and/or Board Certification when applicable; Corporate verification from the Alabama Secretary of State; and any other documentation as may be requested by the City
of Demopolis Revenue Department. This information is used solely for the purpose of determining the correct license code and is retained as strict confidential
information.
OWNER/PARTNER/OFFICERS’ NAMES AND TITLES:
__________________________________________________ _________________________________________________
__________________________________________________ _________________________________________________
__________________________________________________ _________________________________________________
______________________________________________________________ _____________________________________________________________
(Signature of Owner or Officer) (Name of Applicant - Please Print)
Application Received by:
Compliance Confirmed by:
Zoning Approval: ____________________________ Date: ____________
Building Inspector: ___________________________ Date:
___________
Fire Code Approval: ________________________ Date: ___________
Horticulturist Approval: ________________________ Date: ____________
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