City of Evans, Colorado
Business and Tax License for Private Security Service Application
PLEASE TYPE OR COMPLETE IN BLACK INK IN FULL
(Illegible and/or incomplete forms may be rejected)
City of Evans
BUSINESS AND SALES TAX OFFICE
1100 37
th
Street
Evans, CO 80620
(970)475-1109 FAX: (970)330-3472
salestax@evanscolorado.gov
www.evanscolorado.gov
Important: Please keep a copy of this application for your records
**PLEASE COMPLETE ALL SIDES OF APPLICATION**
New Application Renewal Application
Business and Tax License Fee: $25.00 Total Fee: $75.00
Private Security License Fee: $50.00 Annual Renewal due NO LATER THAN December 31
Total Fee: $75.00 after Expiration Date, Renewal Fees Increase to $100.00
SECTION ONE All information provided in this section of the application is considered public information and is required to be released upon public request.
1. Type of Ownership: Sole Proprietor
Partnership Corporation Limited Liability Corporation Other _________________
2. Taxpayer Name (Owner, Partners or Corporate Name): ______________________________________________________________________________
3. Trade Name (“Doing Business As”): ______________________________________________________________________________________________
4. Business Address: ____________________________________________________________________________________________________________
Street City State Zip
5. Mailing Address: _____________________________________________________________________________________________________________
Street City State Zip_
6. Business Phone Number: (_____)______-___________ First Day of Business in Evans: _____/________/_____________________
7. Website Address: ______________________________ Email Address (required): _____________________@_________________
8. Nature of business (check all that apply): Wholesale
Manufacturing Construction Service Retail
Office Only
Mail Order Communications Finance/Insurance/Real Estate
9. What is your main product/service? ________________________________________________________________________________________________
10. Do you sell, distribute, deliver, or grow Medical Marijuana? Yes
No
11. Is this business a: Commercial Building
Private Residence (if private residence, fill our Home Occupation Certificate form)
12. If a private residence, do your customers come to your home? Yes
No
13. If located in Evans, what are your hours of operation? ____________________________ Approximate sq. ft. of business: _______
14. If located in Evans, number of employees (including self): Full-time: _______________ Part-time: _________________________
15. Do you have other locations in Evans? Yes
No (if “YES”, a separate application must be completed for business location)
16. Contact Person: __________________________________________________________ Email (required): _____________________@_________________
__________________________________________________________________________________________(______)_______-_____________________
Address City State Zip Phone
Business and Tax License for Private Security Service Application (continued)
SECTION TWO All information provided in this section of the application is considered confidential.
**PLEASE COMPLETE ALL SIDES OF APPLICATION**
17. Tax Filing frequency: $300 tax/month or more, file monthly
Under $300 tax/month, file quarterly $300 tax/year or less, file annually
18. List Owner(s) or Corporate Officers (attach additional sheet if necessary)
__________________________________________________________________________________________(________)___________-_________________
Name D.O.B. Position Home Phone
_________________________________________________________________________________________________________________________________
Home Address City State Zip Code
__________________________________________________________________________________________(________)___________-_________________
Name D.O.B. Position Home Phone
_________________________________________________________________________________________________________________________________
Home Address City State Zip Code
19. List cities in which your company currently/previously business:
_________________________________________________________________________________________________________________________________
City State Dates
_________________________________________________________________________________________________________________________________
City State Dates
_________________________________________________________________________________________________________________________________
City State Dates
20. Accountant or CPA or Local Manager: _________________________________________________________________________________________________
(Person who can provide sales tax information if needed)
___________________________________________________________________________________________(_______)__________-__________________
Address City State Zip Daytime Phone
21. Former Owner’s Name (if applicable): ____________________________________________ Former Owner’s License Number: _________________________
22. Former Name of Business: _____________________________________________________ Date of Purchase: __________/___________/_________________
23. Did the purchase price include fixed assets, machinery, or equipment? Yes
No Value $ _________________________
24. State of Colorado Tax License Number: ___________________________________________ Federal Employer ID (FEIN): _____________________________
SECTION THREE Please complete the following:
25. Has any officer, director, or partner of the company ever been convicted of a felony, misdemeanor, or ordinance violation involving moral turpitude within the
past ten (10) years, excluding traffic violations? ____________
If yes, explain: ____________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
26. Has any officer, director, or partner of the company ever had a judgment or conviction for fraud, deceit, or misrepresentation entered against them within the past
ten (10) years? ____________
If yes, explain: ____________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
27. Describe the nature and type of business to be conducted or services to be offered and the area expected to be covered. __________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
28. Number of vehicles: ______________________ Describe vehicles used (year, make, color, license plate number, etc.) __________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
29. Describe uniforms used (color, badges, insignia, etc.): _____________________________________________________________________________________
_________________________________________________________________________________________________________________________________
30. Describe any other equipment to be used in the conduct of business. __________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
City of Evans, Colorado
Business and Tax License for Private Security Service Application
PLEASE TYPE OR COMPLETE IN BLACK INK IN FULL
(Illegible and/or incomplete forms may be rejected)
City of Evans
BUSINESS AND SALES TAX OFFICE
1100 37
th
Street
Evans, CO 80620
(970)475-1109 FAX: (970)330-3472
salestax@evanscolorado.gov
www.evanscolorado.gov
Important: Please keep a copy of this application for your records
**PLEASE COMPLETE ALL SIDES OF APPLICATION**
Ordinance/Rules and Regulations: All firms should obtain a copy of Chapter 5.32 of the Evans Municipal Code; and Rules and regulations
promulgated by the Chief of Police.
Caution: A license issued under the provisions of Chapter 5.32 Evans Municipal Code is issued provisionally and its issuance is based upon
reliance of the statements of the applicant that he or she is a person eligible to be so licensed. Any license so issued shall become null and void
upon written notification to the applicant that he or she is a person prohibited from being so licensed or has been found to have made false or
misleading statements in this applications.
Signed: ________________________________________________________ Dated: ___________________________
(Name of person completing this document)
Printed Name: ________________________________________________________
Date Fingerprinted: ___________________________________ By: ____________________________________________________
Chief of Police Signature: __________________________________________________________________________________________
WHERE DO I GO TO GET INFORMATION ON LICENSING FOR THE STATE OF COLORADO?
When opening a new business in the State of Colorado, call the Colorado Business Assistance Center, (303)592-5920 in Denver, or (800)333-
7798 toll-free in Colorado for information. Taxpayers are still required to remit State and County taxes directly to the State of Colorado.
To obtain a sales tax, wage withholding tax, or other business tax account number, visit the Denver Service Center at 1375 Sherman St, Denver,
or at the Fort Collins Service Center at 1121 W Prospect Rd, Bldg D, Fort Collins or any Taxpayer Service Center in Colorado. You may also
get the “Colorado Business Registration” Form (CR 0100) through the Colorado Department of revenue website at www.taxcolorado.com
, or
call the Forms Hotline at (303)238-FAST (3278).
Please be sure to check with other departments of the City to ensure compliance with all other applicable laws and regulations. Issuance of
the Business and Sales Tax License does not mean conformance with Zoning provisions and/or other requirements.
Pursuant to Section 3.04.500 (l) of the City of Evans Tax Code “failure to obtain a renewal license by the December 31
st
expiration date
shall result in payment of an increased renewal fee…
Thank You.
I declare, under penalty of perjury in the second degree, that this application has been examined by me, that
the statements made herein are made in good faith pursuant to Colorado and the City of Evans tax laws and
regulations, and to the best of my knowledge and belief, are true, correct, and complete.
click to sign
signature
click to edit