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. __________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________