City of Northglenn                      Phone: 303-450-8729
                                            Sales Tax Division                      Fax: 303-450-8708
                                            11701 Community Center Drive            Email: salestax@northglenn.org
                                            Northglenn, CO 80233-1001               Website: www.northglenn.org/taxes

                                            BUSINESS LICENSE APPLICATION

Pursuant to City Code Section 5-3-8(a)(b) It shall be unlawful for any person to engage in the business of selling at retail, as the same is defined in this Code,
tangible personal property and services subject to the tax imposed by this Code, without first having obtained a license therefore, as provided by Section 5-3-19.
Every person, retailer or lessor, who comes within the definition of "engaged in business in the City," as defined, shall obtain a Sales and Use Tax License in
order to do business in the City of Northglenn. Merely obtaining a business license does not excuse, nor supersede any other permits and/or
approvals necessary to actively engage in business within the City. It is the responsibility of each business to acquire all of the appropriate permits,
licenses, and/or approvals as listed in the ‘New Business Checklist’ prior to conducting business within the City.

APPLICATION FOR ONE OF THE FOLLOWING:
                                                                                    (Office Use Only)
    Business License - $15 Fee (Service or Sales)
                                  OR                                  License Number: 99- __ __ __ __ __ __
    Home Occupation Business License - $15 Fee
     (Enclose Home Occupation Agreement)                               Business Type: ______ Geo Code/Org: ______
                                  OR
    Exempt Institute License – No Fee                                 Lot: ______ Cust: ______ NURA: __ Yes __ No
     (Enclose a copy of the IRS 501(c)(3)
     Letter of Exemption)

1. Filing Frequency: If Sales Tax Collected is:
    $100/quarter or less – ANNUALLY                                      Check this box if company creates its own
                                                                           tax returns and does not need the City of
    $100/month or less – QUARTERLY                                        Northglenn to supply them. (Enclose a
                                                                           copy of created tax return for City
    $100/month or more – MONTHLY                                          approval)

     Filing frequency subject to City approval. Annual filing status is typically granted to service businesses,
     wholesalers, & non-profit 501(c)(3) organizations

2. Indicate Type of Organization:

    INDIVIDUAL                                  PARTNERSHIP                                                    NON-PROFIT (501(c)(3) non-
    ASSOCIATION                                 ESTATE/TRUST                                                    profits must enclose copy of IRS
    LIMITED LIABILTY COMPANY                    CORPORATION                                                     exemption letter)
    GOVERNMENT                                  LP, LLP, LLLP

3. Full legal name of Business or Corporation:
4. Trade Name (Doing Business As):
5. State of Colorado Sales Tax License #:                                                                         (Enclose a copy of the license)
6. Physical Business Location (Street & Unit #):
     City                                         State                  Zip Code                                      Square Feet
                                                                     AK
     Landlord (if business located in Northglenn)                                                                 Phone
7. Mailing Address (if different from location address):
     City                                                                  State                                  Zip Code
                                                                                  AK
                                                  Continued on next page

8.  Business Location Phone:                                        Fax:
9.  Business Website Address:
10. Nature of Business/Type of Sales:

11. North American Industry Classification System (NAICS) Code (if known):
12. Days and Hours of Business Operation:                                               # of Employees:
13. Date business activity began or will begin in Northglenn:  ____________________________________
14. Did You Purchase an Existing Business?:        Yes          No  If Yes, Date of Purchase
    Name of Prior Owner and Business Name
15. List any other current or past businesses (within the past 5 years) owned in Northglenn:
    1.                                                          2.
16. *List all principal owners, partners, and or corporate officers (attach an additional sheet if necessary):
    1. Name                                 Home Address
      Title                                 Home Phone                           Cell Phone
      Date of Birth                                     Email Address
      Valid Identification Number _______________________________ Valid Identification Type__________________  

    2. Name                                 Home Address
      Title                                 Home Phone                           Cell Phone
      Date of Birth                                     Email Address
      Valid Identification Number __________________________________ Valid Identification Type_______________  
                                                                                             Military ID Card
    * Valid proof of identification includes a State Driver’s License, State Identification Card, U.S. Passport, Resident Alien Card,
    and/or Military Identification card. Enclose a legible copy of valid identification.
17. Colorado Registered Agent (if Corporation or LLC):
    Address                                                         ____                               ___
    Phone                                   Fax                      Email
18. Contact for Business Records/Accountant:                                            Phone
    Address                                                                      Email
19. Emergency Contact Name:                                                      Phone
“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 Northglenn tax laws and regulations, and to the best of my knowledge and belief, are true, correct, and complete. I
also understand that additional permits and/or approvals (as described in the ‘New Business Checklist’) will be necessary prior to conducting
any business within the City of Northglenn.”

Signature of Owner/Officer                                                       Date

Printed Name                                                        Title  _____________________________________

          Incomplete applications will not be processed. Applications will not be processed until
                    $15.00 license fee is received. Please allow 20 days for processing.
                    Items noted with an asterisk (*) are kept strictly confidential.
                                                PRINT & SIGN IN BLUE OR BLACK INK