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Applications are accepted in person Mon-Fri 8AM-4PM Or by Mail (OFFICE USE ONLY) REG# CITY OF ANAHEIM BUSINESS TAX INPUT FORM City of Anaheim - Business License Division 200 S. Anaheim Blvd #136, Anaheim, CA 92805 P.O. Box 61042, Anaheim, CA 92803-6142 (714) 765-5194 New Application Business Name Change Address Change New Owner Open/Start Date in Anaheim Have you had a business in Anaheim within the last 5 years? Yes No SECTION A – BUSINESS INFORMATION Business Address (CANNOT be a P.O. Box or PMB) Street No. Direction (N-S-E-W) Street Name City State Zip Business Name/D.B.A._ Corporation/Partnership/LLC Name (If different from above) Mailing Address (If different from business address) BUSINESS Phone ( ) FAX ( ) Email/Website After Hours (In town Businesses Only) Emergency Contact Name (Local) Emergency Phone Federal ID# State ID # _ Resale # (E.I.N. (Seller’s Permit Please Describe Your Business Activity If you hold a State License, please provide: State License # Type(s) Expiration Date SECTION B – OWNER INFORMATION Please check the appropriate ownership type: Sole Ownership Partnership Corporation Joint Venture Limited Liability Co. Limited Partnership Receiver Trust Other: Please List Information Regarding Business Owners, Partners, or Corporate Officers: (Last Name/Title) (First Name) (Phone No.) (Social Security#) (Driver’s Lic# and State) (Provide Full Legal Name) (PRIMARY Owner) PRIMARY Owner’s Home Address: Street No. Street Name City State Zip Page 1- PLEASE COMPLETE REVERSE SECTION ---PAGE BREAK--- Page 2 (continued) SECTION C – TAX INFORMATION (Please only complete the information pertaining to your business.) Total Number Of Employees In Anaheim Alcohol Use Type _ (ALL businesses must complete) (Only For In Town Businesses that sell Alcohol ) Estimated Annual Gross Receipts(Sales) (Retail, wholesale, manufacturing, entertainment venues, telecommunication, motel/hotels, & miscellaneous sales) Total Gross Square Footage Number Of Units (Commercial leasing, warehousing, and storage) (Apartments & Motel/Hotels) Number Of Professional Owners/Partners No. Of Professional Employees _ (For professional services e.g.-lawyers, accountants, doctors, dentists) (Professional services that hire professional employees) No. Of Other Employees Other: (Professional service employees other than listed above) (Carnival/Bowling Alley/Billboard/Swap Meet/Etc.) FEES MUST ACCOMPANY THIS APPLICATION, PLEASE CALL OUR OFFICE FOR TOTAL AMOUNT DUE. PLEASE MAKE CHECKS PAYABLE TO: THE CITY OF ANAHEIM OFFICE USE ONLY Expiration Date Tax (1141) Processing (1142) $ Fee Schedule Penalty (1143) $ Interest (1144) $ SIC Code Permits (1149) $ Home Occ. (3083) $ TOTAL $