CITY USE ONLY Date Received: _____________ Date Issued: ________________ License No: _________________ Business License No: ____________ Form 101.0.04.17 GENERAL BUSINESS LICENSE **License Fee $20.00** Ownership: Individual Partnership Corporation Nonprofit (attach tax-exempt letter) LLC LLP Business Type: Retail sales Home occupation Wholesale Utility Construction Leasing Financial Institution Government Hospitality Transportation Professional Services Manufacturing CONTACT INFORMATION: Taxpayer Entity Name (Owner, Partnership, Corp): ___________________________________________________ Trade Name of Business (d/b/a): ____________________________________________________________________ Physical Address of Business: ______________________________________________________________________ Mailing Address, including Unit #: _________________________________________________________________ Business Phone: _________________________________________________________________________________ Business Email Address: __________________________________________________________________________ Website: __________________________________________ Fully describe business operations: 7887 E. 60th Ave., Commerce City, CO 80022 Tel: 303-289-3611 Fax: 303-227-8798 www.c3gov.com |
General Business License Form 101.0.04.17. Page 2 __________________________________________________________________________________________________ __________________________________________________________________________________________________ LIST POINT OF CONTACT FOR TAX AND AUDIT INQUIRIES: Tax Contact Name: ________________________________________________________________________________ Phone: _______________________________ Email: _____________________________________________ Federal Employer ID No. (FEIN): _______________________ Colorado State ID: __________________________ Estimated Start Date in Commerce City (Required): _____________ Estimated Tax Due: ________ Filing Frequency: ☐Monthly (more than $50 tax/month) No. of Employees: __________ ☐Quarterly (less than $50 tax/month) Full Time: ☐Annually (less than $10 tax/month) Part Time: PLEASE LIST ALL PRIMARY OWNERS, PARTNERS, OFFICERS OR MEMBERS IN THE BUSINESS: Name: __________________________________________________ Title: _________________________________ Address: __________________________________ City: _______________________ State: _____ Zip: ________ Phone: __________________________________ Email: ________________________________________________ Name: __________________________________________________ Title: _________________________________ Address: __________________________________ City: _______________________ State: _____ Zip: ________ Phone: __________________________________ Email: ________________________________________________ Name: __________________________________________________ Title: _________________________________ Address: __________________________________ City: _______________________ State: _____ Zip: ________ Phone: __________________________________ Email: ________________________________________________ Attach additional ownership/officer sheets if necessary. IF YOU ACQUIRED THE BUSINESS IN WHOLE OR IN PART, PLEASE COMPLETE OR ☐ N/A Prior Owner’s Name: _____________________________________________________________________ Prior Owner’s Address: ___________________________________________________________________ City: ___________________________________________ State: _______ Zip: ___________________________ 7887 E. 60th Ave., Commerce City, CO 80022 Tel: 303-289-3611 Fax: 303-227-8798 www.c3gov.com |
General Business License Form 101.0.04.17. Page 3 Date of Acquisition: Purchase Price: _______________________________ Price of Personal Property (Furniture, Fixtures, Equipment & Supplies): ___________________________________ PROVIDE COPIES OF ANY OTHER PERMITS NEEDED TO REGULATE BUSINESS: ☐ Colorado Department of Regulatory Affairs ☐ Colorado Department of Public Health & Environment ☐ Tri-County Health Department ☐ Colorado Department of Labor & Employment ☐ Colorado Department of Human Services ☐ Other (specify): Click here to enter text. ☐ Not Applicable (N/A) Do you store or display outdoor materials? ☐ No ☐ Yes, specify type ______________________________ Do you store or use hazardous materials? ☐ No ☐ Yes, specify. __________________________________ I hereby certify under penalty of perjury that the statements made herein are true, correct and complete to the best of my knowledge. I hereby acknowledge and agree that if I have provided any false or misleading information herein, the City of Commerce City is authorized to immediately suspend or revoke any license issued pursuant to this application and issue a Stop Work Order to the licensed business. I further agree that I and the business named herein shall comply with all requirements of the ordinances and regulations of the City of Commerce City, including the duty to supplement the information provided herein. This application is only for a City of Commerce City business license; additional land use, zoning, building permit or license approvals may be required. Applicant Signature: _________________________________________________________________ Title: _______________________________________ Date: ________________________ Applicant Name (Printed): ____________________________________________________________ Direct Phone Number: ________________________________________________________________ Submit The City will occasionally email you relevant business and regulatory information unless you decide to opt out by checking this box ☐. 7887 E. 60th Ave., Commerce City, CO 80022 Tel: 303-289-3611 Fax: 303-227-8798 www.c3gov.com |