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Business Tax Determination Department of Finance P.O. Box 1178 Billings MT. 59103 [PHONE REDACTED] This Business is New business Transfer Former Owner Name Name Change Former Business Name_ Please Print 1. Name of Business (DBA) 2. Nature of Business 3. Location of Business Street Address City St zip 4. Mailing Address Street Address City St zip 5. Name of Applicant Owner Manager other Partner 6. Date Business is to Start in Billings 7. Business phone Home phone/ 2nd phone 8. Business is in Residence Existing Building Out of City 9. Business is Sole Proprietor Partnership Corporation Other 10. Email address Fee Computation Basic Tax $ Liquor all Beverage $ ($500.00) Full time Employees Liquor fee Beer $ (Excess of 5: $6 ea) ($200.00) Health fee $ Liquor fee Wine $ ($50.00) ($200.00) Delivery permits $ Total Fee Due $ ($12.00 each) Include License plate # Payment must be included to process application Pursuant to Ordinance No. 12-5587 enacted by the Billings City Council on October 9, 2012, any business, occupation or profession within the City that violates any provision of local, state, or federal ordinance, regulation, law, or statute is expressly prohibited. The issuance of a Business Tax Determination or acceptance of payment by the City does not authorize any business, occupation, or profession to operate in violation of any provision or local, state, or federal ordinance, regulation, law, or statute. Any such Business Tax Determination or Business License improvidently granted by the City shall be deemed void from the date of issuance. By signature below, the applicant asserts under penalty of law that the proposed business, occupation, or profession does not violate any provision of local, state, or federal law, statute, ordinance, or regulation. Signature: Date: Signature: Date: SIGN SIGN