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Finance Dept APPLICATION FOR SALES AND USE TAX LICENSE NO FEE REQUIRED Owner’s or Corporate Name Name of Business (DBA) Business Address (Street, City, State, Zip) Mailing Address (Street, City, State, Zip) Nature of Business (Type of sales/service) Does your business acquire, possess, cultivate, manufacture, produce, use, sell, distribute, dispense, or transport medical marijuana? Yes No Ownership Individual Partner Corp Other (explain) Federal Employer Identification Number (FEIN) or Social Security Number (SSN) – Application will NOT be processed if missing State of Colorado Sales Tax Account Number – Application will NOT be processed if missing Filing Period QUARTERLY ANNUAL NOTE: If the average for remittance is $40 or greater, filing is required. If less than $40 per year or fewer than two sales transactions are expected, annual filing is desired. Will you be printing your own returns through your tax software? Yes No - They are not available on-line Date business will begin in Lafayette If business was purchased, list name of former owner and business name (if name listed above is new) Sales Tax Contact Name and Title Business phone number Business fax number I, DECLARE, UNDER PENALTY OF PERJURY THAT THIS APPLICATION HAS BEEN EXAMINED BY ME AND THE STATEMENTS MADE HEREIN ARE MADE IN GOOD FAITH PURSUANT TO THE CITY OF LAFAYETTE TAX LAWS AND REGULATION AND, TO THE BEST OF MY KNOWLEDGE AND BELIEF ARE TRUE, CORRECT, AND COMPLETE. Printed Name Title . Signature Date . Please mail or fax the application to: City of Lafayette - Sales Tax PO Box 250 Fax (303) 665-2153 Lafayette, CO 80026 Phone (303) 665-5588