FINANCE DEPARTMENT                                  SaleS/USe Tax licenSe
                                                      SALES TAX DIVISION 
                                                                                                                   applicaTion
                             911 10TH ST.      GOLDEN, CO 80401
                                                                                                                               Fee $20.00
Certicates will not be issued unless this form is lled out entirely.                                               Questions regarding application 
Please mark all that apply.                                                                               phone: (303) 384-8024  ·  Fax: (303) 384-8001

BUSineSS inFormaTion
                                                                                                          q New Business in Golden
Business Name  
Physical Address                                                                                          q Home-Based Business
City                                           State                   Zip  
Business Phone:   (        )                   Business Fax:   (        ) 
                                                                                                          iSSUance oF yoUr Tax 
Business Web Address:                                                                                     
                                                                                                          licenSe doeS noT imply 
Business Email:  
                                                                                                          compliance wiTh all 
mailing inFormaTion                                                                                       ciTy deparTmenTS or 
Mailing Address                                                                                           oTher jUriSdicTionS
City                                           State                   Zip  
Reporting Frequency:         q Monthly      q *Quarterly            q *Annually
* Please note, you may only le annually if you have no retail sales and are only providing a service, and quarterly if tax is less than $60.00 monthly.
Have you remitted tax to us in the past?  If so, please note when:  
Taxpayer representative                                                                                 
                             Name                                                               Phone Number
Location of Records:  City                                            State                Zip  
New Business Type of Ownership:  (check one)

                     q Sole Proprietorship            q Partnership                      q Corporation
                     q Non-Prot Corporation (No Fee, Attach Proof)                       q Other, Please Explain   

owner / oFFicer inFormaTion
Owner/President                                                                   Drivers Licence #                              (attach copy)
Vice president                                                                    Drivers Licence #                              (attach copy)
Date you started / Will open business   
Description of business (please detail types of service(s) / product(s) and nature of business  
 
Is your business physically located in the City of Golden?          q Yes    q No        If yes, complete page 2.
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 Golden tax laws and ordinances and, to the best of my knowledge and beliefs, are true, correct and complete.
Print or type name                                                                Title  
Authorized Signature                                                              Title                              Date  

 For ciTy USe only
 Account #                                                                      Entered  
STF Application 10/08

                 iF yoUr BUSineSS iS phySically locaTed in golden - compleTe The Following

BUSineSS inFormaTion
Normal Business Hours   
Do you report hazardous materials under EPCRA or 112R?  q Yes     q No

What is the location of your onsite Hazmat Inventory List?   
What is the location of your onsite Hazmat Storage Plan?   
What is the location of your onsite Material Safety Data Sheet?   
Building Square Footage                             Business Square Footage   
Do you have an alarm system?  q Yes     q No
Fire Alarm Monitoring Company                                             Phone #    Acct #   
Fire Alarm Service Company                                                Phone #    Acct #   
Burglar Alarm Company                                                     Phone #    Acct #   
Burglar Alarm Service Company                                             Phone #    Acct #   
Are you a home based business?
For Home Based Businesses - Number of Employees, including yourself   
If you provide Daycare, # of Children   

owner / oFFicer inFormaTion
Owner/President                                                Home Phone #         Cell #  
Home Address                                                            City        State     Zip  
Vice president                                                 Home Phone #         Cell #  
Home Address                                                            City        State     Zip  
Secretary                                                      Home Phone #         Cell #  
Home Address                                                            City        State     Zip  
Treasurer                                                      Home Phone #         Cell #  
Home Address                                                            City        State     Zip  
Name of previous Business Owner   
Name of previous Business   

                  local emergency conTacTS  (List a minimum of 3 in the order you want them called by dispatch)
Name                                                           Home Phone #         Cell #  
Home Address                                                            City        State     Zip  
Name                                                           Home Phone #         Cell #  
Home Address                                                            City        State     Zip  
Name                                                           Home Phone #         Cell #  
Home Address                                                            City        State     Zip  

                                                                  Page 2

                LAWFUL PRESENCE AFFIDAVIT 
                                        
I, _____________________________________, swear or affirm under penalty of perjury 
under the laws of the State of Colorado that (check one): 
 
□     I am a United States citizen; or 
 
□     I am a Permanent Resident of the United States; or 
 
□     I am lawfully present in the United States pursuant to Federal law. 
 
I understand that this sworn statement is required by law because I have applied for a 
public benefit.  I understand that state law requires me to provide proof that I am lawfully 
present in the United States prior to receipt of this public benefit.  I further acknowledge 
that making a false, fictitious, or fraudulent statement or representation in this sworn 
affidavit is punishable under the criminal laws of Colorado as perjury in the second 
degree under Colorado Revised Statute 18-8-503 and it shall constitute a separate 
criminal offense each time a public benefit is fraudulently received. 
 
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Sier    g natDu                         ate