BUSINESS APPLICATION             
                                                      INSTRUCTIONS 
                                                                    
GENERAL INFORMATION:    
 Application packets with    missing     information/documentation              will not be processed.            
 Be sure to   include the address  of the   physical location     of the   business, the mailing     address where business                    
  licenses/renewals should be      sent,   and the mailing      address   where  sales tax information       should     be sent.             
 Email addresses are   required.       
 NAICS Codes may      be obtained  at       www.naics.com.  
 The number of   full time and  part time    employees      is required     for locations  inside the City of Greeley.                 
 Reporting frequency and     estimated       sales/use   tax liability   is required.        
ADDITIONAL FORMS  
 Sewer Questionnaire        – This form    is   required if you   have a commercial     location   inside the City of Greeley.               
  This includes retail, office, and industrial   locations.            NOTE: Not required     for   home    based  businesses     or      
  businesses located outside     the  City  of Greeley.           
 Affidavit   of Lawful Presence   –    This form is   required for     individual and    sole proprietorships.     One            
  identification from the   list at   the bottom of this   form should    be provided.               NOTE: No    license    will be issued    
  without proof   of   identification.      
 S.A.V.E. Verification Form     –   This form is   required if you     did not select   “I am   a United   States Citizen”  on             
  the Affidavit of   Lawful Presence.        NOTE: We     do not   verify citizenship    through    the Immigration     and           
  Naturalization Service (INS).       
 Home Occupation       Permit   Application     –   This form is   required to   obtain a permit     for home     based             
  businesses. NOTE: Businesses        with   commercial      locations    should not complete        this form.            
 Description   of Vehicles –     This form is   required for      all   refuse haulers doing business    in the   City of Greeley.             

                                                                                                                                                               Clear Form
                                                                 Business                                                                                 () -
                                                                 	                                                                                     FAX () -
                                                                 DD7
                                                                                                                                                          www.

In order to ensure  , please fill in fields   . Incomplete

                                                                                                                                            CITY USE ONLY
                                                                                                                                    A                  
                                       1) Legal/True Name of Business (Last, First if Individual). Repeat on Page 2
                                                                                                                                            &'*&+                 03*
                                       2) Trade Name!	"#!$%) of Business

                                       ) Reason for Filing (check only one)                              )  45*6!
                                        New "#! (Including new location)                             Individual/Sole Proprietor (;
                                        Update Information for Account:___________________                Corporation (Including PC)
  Information                    Business Purchased or Merged                                      Limited Liability Company (LLC)
                                        '!6                                                           Partnership (General or Limited)
PART A -                               8) Location/Account Type (check only one):                          Limited Liability Partnership (LLP or LLLP)
                                        Commercial (Including retail, office, and industrial locations)   Non-Profit
                                        Home Occupation (9*#4! &                                 Trust
                                        Out of City Location(s)                                           Government
                                                                                                           Other Entity Type:

                                                                                                 Location Information

                                       ) Location Manager Name                                                              ) Location &7!=#> ?) Location  Number

                                       ) Location Street Address with Suite Number (No PO Boxes)

                                       1) City                                   1D) State1J) Zip Code                     1) <!K!	

                                                                                  Business Licensing
                                                                 %767
                                       18) Send Business Licensing Correspondence Care Of                 1) Licensing Phone Number        1) Licensing Fax Number

                                       D) Check the following if the licensing address is:      D?) Mailing Address for Business Licensing Correspondence
                                        Same as Location Address (lines  - 1 above)
                                                                                                 D) City                                   2) State2D) Zip Code

                                                                                             Tax 
                                                                        %767
                                       2J) Send Tax Correspondence Care Of                                2) Tax Phone Number              28) Tax Fax Number

PART B - Address & Contact Information 2) Check one of the following if the tax address is:     2) Mailing Address for Tax Forms, Notices, and Correspondence
                                        Same as Location Address (lines  - 1 above)
                                        Same as Licensing Address (lines 1? - 2D above)         J) City                                   J?) StateJ) Zip Code

                                       3) Check one of the following if the records address is: 3D) Address where Tax Records may be Inspected (No PO Boxes)
                                        Same as Location Address (lines  - 1 above)
                                        Same as Licensing Address (lines 1? - 2D above)         3J) City                                   3) State38) Zip Code
                                        Same as Tax Address (lines 2 - 2 above)
                                       	
                                         Primary E-mail Address:                                                  Alternate E-mail Address:

This form has 2 pages. Both pages must be completed. Incomplete

Business                                                                                                                                                                       Page 2
3) Legal/True Name of Business (From Part A, Line 1)

                                             3) Name of principal officer, owner, partner, member, or manager                ) Title

                                             ?) Address of principal residence                                      ) City                                          4) State4D) Zip Code

                                             4J) Name of other officer, owner, partner, member, or manager                    4) Title
                -! "Officers
                                             48) Address of principal residence                                      4) City                                          4) State8) Zip Code
                PART C
                                                                 Additional officers, owners, partners, members, or managers may be included on attachments.
                                             8?) Legal Name of Prior "#! (if purchased or merged)                                                                 ) Purchase/Merge Date

                                             5) 

                                             5) Hours of Operation (local businesses only)
                                                                 Monday         Tuesday               Wednesday      Thursday                 Friday             Saturday         Sunday
                                                        From
                                                          To
                                             5 ) j> Address                                      W(=$+V|                                        Number of Employees at this Location
                                             http://                                                                                                         5 )FT          5)PT
                                              )	 Primary Business Type (check only one)      '                j7                          
                                              K!#5                                       $                      {                            '3z'!<!	
                                                                                             Construction           +!5
                                              $V!zV                          97               *7
                                              ) Description of Goods Sold or Services Provided                                )'Check this box if you    ) State Child Care License Number
                                                                                                                              intend to sell liquor.
PART6) RequestedD - BusinessReportingInceptionFrequency& Operations 
                                                        Monthly  Quarterly  )**+,-                                            
                                             Every business must file at least annually, even if no tax is due.All businesses, including those that do not!"#!$% &

                                                                                                                     ; //*+

                                                                 .+/00%+0#0 1-*2+1-+/-+-+-3% +4

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                                                                 :+)** /+,+-230//*4

     -
                                
    PART

                                                                           +V
                                                                           7
                                             Signature of
                                             
                                             Authorized
                                                                                    Signature                                                                                Date
                                             Agent

                                                                                    Printed Name                                                             Title

                                                                                                      Clear Form
                                                            
                                                    CITY OF GREELEY 
             COMMERCIAL SEWER USER CLASSIFICATION QUESTIONNAIRE 
 
When a business is opened or changes hands, the sewer account is reviewed for proper billing classification.  It is important 
that you fill out this questionnaire accurately and completely, to ensure your business is receiving the correct billing rate.  
Please return this questionnaire along with your Sales Tax License Application. 
 
Name of Business: ___________________________________________________________________________________ 
 
Short Business Description: ___________________________________________________________________________ 
 
_________________________________________________________________________________________________ 
 
Contact Person:  ___________________________________________________________________________________ 
 
Is this a home-based business?  _______yes*   _______no 
*If yes, then please stop here and return the form. 
 
Outside Landscape square footage (this information is very important in establishing correct sewer billing information for 
commercial businesses.) 
                             2                          2
_______ Less than 15,000 ft    ______ more than 15,000 ft  
 
Please read the following classifications to determine which class your business best fits, and check the appropriate one.  If it 
does not fit into any of the following classes, then please explain: 
 
_________________________________________________________________________________________________ 
 
__________________________________________________________________________________________________ 
 
__________________________________________________________________________________________________  
 
_____Class I:  includes retail stores, offices, car washes, cleaners, laundromats, schools, colleges, churches, beauty shops, 
financial institutions, membership organizations without dining facilities, motels without dining facilities, gas stations without 
repair, and bed and breakfasts that serve only a continental breakfast. 
  
____Class II:  includes bars and taverns without dining, service stations and garages with repair, animal clinics, 
hospital/convalescent homes, photo finishing, light manufacturing, coffee shops, convenience stores, and bed and breakfasts 
that cook a daily breakfast. 
 
____Class III:  includes restaurants, hotels with dining facilities, bars and taverns with dining, and membership organizations 
with dining. 
 
____Class IV:  includes food markets (grocery stores), butchers, bakers, and food manufacturing. 
 
____Class V:  includes mortuaries and miscellaneous heavy commercial manufacturing. 
 
If you have any questions, then please contact the City of Greeley Industrial Pretreatment Program at 
                         970-350-9363. Thank you for your cooperation and assistance. 
                                                            

                                                                                                                   Clear Form

                                   AFFIDAVIT OF LAWFUL PRESENCE 
             
    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. 

    ___________________________                                             _______________
    Signature       Date 
     
*If Affiant affirms that he/she is either a Permanent Resident or otherwise lawfully present in the United States, please have 
Affiant complete the S.A.V.E. verification form and forward both forms to H.R. for verification of lawful presence in the 
                                                                
S.A.V.E. program.  
                                                                
For internal use only:                                            For internal use only: 
            IDENTIFICATION                                         ALTERNATE I.D. REQUIREMENTS 
                    PROVIDED                                       
                                                                  If applicant cannot produce one of the identification 
   Current Colorado Driver’s License or Permit                   documents listed at left, please refer to Attachments A 
   United States passport                                        and B of the Department of Revenue’s “Rules for 
   Current Colorado Identification Card Issued by                Evidence of Lawful Presence” located at U:\City 
    Department of Motor Vehicles                                  Attorney\Immigration  
   United States Military ID/Common Access Card                   
   United States Military Dependent Identification Card          Questions?  Contact the City Attorney’s office. 
   United States Coast Guard Merchant Mariner Card  
   Native American Tribal Document 
   Out of State DL/ID from any state except Alaska, Illinois, 
    New Mexico, Utah, or Washington. 
   Out of State DL/ID that says “Enhanced” 
   Foreign passport with photo, US Visa, I-94 
   Certificate of Naturalization w/photo less than 20 years 
    old 
   Certificate of Citizenship w/photo less than 20 years old 

                          S.A.V.E. VERIFICATION FORM 
                                         
Pursuant to Section 24-76.5-103 of the Colorado Revised Statutes, the City of Greeley 
must verify that individuals who apply for public services from the City are lawfully 
present in the United States.  If an Applicant executes the Affidavit stating that he or she 
is an Alien lawfully present in the United States, the City of Greeley must verify such 
lawful presence through the federal Systematic Alien Verification of Entitlement program 
("SAVE program").  This verification program is operated by the United States 
Department of Homeland Security. 
 
The following information is required in order for the City to perform the SAVE program 
verification.  In addition, please affix to this form a legible copy of your identification or 
other documentation which demonstrates lawful presence in the United States. 
 
Name___________________________________________________________________ 
 
Telephone Number _______________________________________________________ 
 
Social Security Number ___________________________________________________ 
 
Date of Birth ____________________________________________________________ 
 
City Benefit requested:    Food Tax Rebate 
      Water and Sewer Department Rebate 
                           Commercial/Professional License  
                           Liquor License  
                           Loan (including Historic Preservation loans) 
                           Grant 
                           Emergency Assistance 
 
  For internal use only: 
                                          
  Requesting Department________________________________________________________________ 
  Staff contact ________________________________________________________________________ 
   
  Forward the Affidavit, SAVE Verification form, and copy of appropriate identification documents to H.R. 
 
  H.R. use only: 
       S.A.V.E. verification performed 
            o    Affiant is lawfully present in the United States 
            o    Affiant is not lawfully present in the United States 
   
       Documents returned to originating Department. 
 
U:\City Attorney\Immigration\1023 affidavit of lawful presence COG USE.doc 

                                                                                                                                                    ClearFee:Form$25 
                                               Home Occupation Permit 

                                                                                                                        
                                                             New                                                            Renewal             
 
Applicant:                                                                                                                         Phone:                              
 
Business Name:                                                                                                                      
 
Street Address:                                                                                                                    Zip Code:                           
 
Email:                                                                                                                          
 
Summary of zoning criteria in Section 18.36, Home Occupations, of the 1998 City of Greeley Development Code, (rev. 2006): 
 
•      The exterior appearance of the dwelling and lot shall not be altered, nor shall the occupation within the dwelling be conducted in a manner which 
       would cause the premises to differ from the residential character either by the use of colors, materials, construction, lighting or signage, or by the 
       emission of sounds, noises, dust, odors, fumes, smoke, or vibrations detectable outside the dwelling. 
 
•      All persons involved in carrying on the home occupation on the premises shall be legal and regular inhabitants of the dwelling unit. No other 
       employees associated with the home occupation may be at the site for the purpose of conducting any part of the business operation. 
 
•      The dwelling unit shall continue to be used primarily for residential purposes, and the occupational activities shall be harmonious with the 
       residential use. 
 
•      There shall be no sale and/or display of merchandise which requires customers to go to the property. 
 
•      Vehicular traffic associated with the home occupation shall not adversely affect traffic flow and parking in the area. No more than 1 customer or 
       client vehicle associated with the home occupation shall be at the home at a time, and no more than ten (10) customer/client visits to the home per 
       week shall be allowed, and no more than two (2) trips per week shall be related to the delivery of products and/or materials, with the exception of 
       day-care homes.* 
 
•      The area used for the home occupation must not exceed 20% of the habitable portion of the dwelling unit, except where the home occupation is a 
       board-and-care home or child-care home. 
 
•      The home occupation shall be confined within the dwelling and shall not include use of the garage, whether attached or detached, except for the 
       parking of a vehicle associated with the home occupation. 
 
•      The use of utilities shall be limited to that normally associated with the use of the property for residential purposes.  
 
•      There shall be no on-premise signs advertising the home occupation. 
 
•      Activities conducted and equipment and materials used or stored shall comply with the Building Code. 
 
•      There shall be no use or storage of mechanical equipment or materials not recognized as being a part of normal household or hobby use. 
 
•      Only one vehicle not to exceed one-ton capacity and one trailer which cannot exceed 15 feet may be related to and used in conjunction with the 
       home occupation and shall be parked on-site. Such parking shall not be located within any setback. 
 
•      Only one home occupation shall be permitted per residence, unless more than one home occupation can be operated using the same area within the 
       residence, which shall constitute no more than 20 percent of the living space and can operate within the parameters of a single home occupation. 
 
•      A fee of $25 is assessed for this permit. 
 
*Permitted home occupations that would otherwise exceed 10 trips per week shall be considered a major home occupation and shall be required to submit the 
home occupation request as a Use by Special Review meeting the provisions of Chapter 18.20 regarding special review. 
 
This is to certify that I am a responsible party for the aforementioned business and understand the conditions of Section 18.36 of the 
Greeley Development Code which regulates home occupations and agree to abide by the conditions stated herein.                                                 
 
Signature                                                                                                                      Date 
 
                                                           FOR OFFICE USE ONLY 
   
  ________________                             _______________________________________________                                                 _________________ 
  Zone                                         Planner                                                                                         Date 
Zone:Payment:   ______________________ Cash   Check     Credit Card                                                     Permit expires: __________________________