Fillable PAYMENT SUMMARY OWNERSHIP INDIVIDUAL OR PARTNERS TO BE (The Tulalip Tribes)

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PAYMENT SUMMARY OWNERSHIP INDIVIDUAL OR PARTNERS TO BE (The Tulalip Tribes)

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The PAYMENT SUMMARY OWNERSHIP INDIVIDUAL OR PARTNERS TO BE (The Tulalip Tribes) form is 1 page long and contains:

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  • 68 other fields

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RETAIL FIREWORKS STAND APPLICATION
PLEASE USE DARK INK. IF ANY ITEM IS NOT APPLICABLE OR NO INFORMATION IS AVAILABLE, INDICATE BY MARKING
WITH “N/A” OR STRIKE THROUGH. INCOMPLETE AND/OR ILLEGIBLE APPLICATIONS WILL BE RETURNED TO APPLICANT.
The Tulalip Tribes of Washington
Community Development Department
TAX & LICENSING DIVISION
6406 Marine DR NW
Tulalip
, WA 98271
Telephone: (360) 716-4204
PAYMENT SUMMARY
FEE
Enclose payment for total amount due, including application and applicable penalty fees. Accepted
forms of payment are cash, check, and money order made payable to The Tulalip Tribes / TLD.
License fees are not pro-rated and are nonrefundable.
APPLICATION FEE
$ 35.00
TOTAL AMOUNT DUE
$
OWNERSHIP – INDIVIDUAL OR PARTNERS TO BE LICENSED
Please choose one:
INDIVIDUAL
PARTNERSHIP
Licensee Name (Last, First, Middle)
D.O.B.
/ /
Enrollment Number
T#
Home Address (Street or Route, PO BOX)
Home Telephone #
( ) -
City State, Zip
Day Telephone #
( ) -
Stand Number:
#_____
Stand Name:
Partner Name (Last, First, Middle)
D.O.B.
/ /
Enrollment Number
T#
Home Address (Street or Route, PO BOX)
Home Telephone #
( ) -
City State, Zip
Day Telephone #
( ) -
STAND ASSISTANTS
Title 10, SECTION 10.25.140– (1)(a) Any adult Tulalip Tribal member. (b) A licensee’s spouse. For purposes of this code, a “spouse” means a person who is
married to another under the law, but does not include a person who is living separate and apart from his or her spouse and who has filed, in an
appropriate court, a petition for legal separation or dissolution of marriage. (c) A parent or step-parent of the licensee, providing that the licensee’s parent or
step-parent has not remarried.(d) A person over the age of 16 years of age who is a child, step-child, or adopted child of a Tulalip Tribal member licensee,
and who is supervised by this same licensee. A step-child is no longer a step-child if the licensee is remarried or deceased.
Assistants
Assistant Name (Last, First, Middle)
D.O.B.
/ /
ID#
Tribal
Spouse
Assistant Name (Last, First, Middle)
D.O.B.
/ /
ID#
Tribal
Spouse
Assistant Name (Last, First, Middle)
D.O.B.
/ /
ID#
Tribal
Child of
Assistant Name (Last, First, Middle)
D.O.B.
/ /
ID#
Tribal
Child of
STAND ASSISTANTS - MINOR(s) *MUST BE 16 YEARS OF AGE
Assistant Name (Last, First, Middle)
D.O.B.
/ /
ID#
Tribal
Other
Assistant Name (Last, First, Middle)
D.O.B.
/ /
ID#
Tribal
Other
Assistant Name (Last, First, Middle)
D.O.B.
/ /
ID#
Tribal
Other
Assistant Name (Last, First, Middle)
D.O.B.
/ /
ID#
Tribal
Other
SIGNATURE REQUIRED *BOTH PARTNERS MUST SIGN
Your signature attests to the accuracy of the information provided and that your business will comply with all applicable Tribal and Local Laws
BY SIGNING BELOW, I UNDERSTAND AND AGREE TO THE FOLLOWING:
I, THE UNDERSIGNED DECLARE UNDER PENALTY OF PURJURY AND/OR REVOCATION OF ANY LICENSE GRANTED, THAT I HAVE EXAMINED THIS APPLICATION
AND THE INFORMATION CONTAINED HEREIN AND/OR ATTACHED, AND THE INFORMATION PROVIDED BY ME AND MY PARTNER IS TRUE AND CORRECT. I
SWEAR OR AFFIRM TO COMPLY WITH ALL TRIBAL LAWS AND CONSENT TO THE JURISDICTION OF THE TRIBAL COURT OF THE TULALIP TRIBES AND SERVICE
OF PROCESS IN MATTERS ARISING FROM THE CONDUCT OF BUSINESS.
Licensee Signature
Date
Partner Signature
Date
STAND NUMBER
FOR OFFICIAL USE ONLY
BC 2014
LICENSEE NAME(S)
/
Tribal ID(s)
Marriage Cert
Asst. Forms & IDs
Other
A
B
D
C
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PAYMENT SUMMARY OWNERSHIP INDIVIDUAL OR PARTNERS TO BE (The Tulalip Tribes)

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Completed 20 July 2020

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