For Office Use Only 
                                                                                                                                                                                                                                                                                                                                                                                                                    
                                                                                                                                                                                                                                                                                                                                                                                                                   Acct#   ___  ___  ___  ___  ___  ___ 

                                                                                                                                                                       City of Chicago 
                                                                                                                                                                       Tax Division 
                                                                                                                                                                     DePaul Center Room 300 
                                                                                                                                                                       333 S. State Street 333 S. State Street 
                                                                                                                                                                       Chicago, IL 60604 Chicago, IL 60604 
                                                                                                                                                                                    
                                                                                                                           ( PleasePlease( DoDo NotNot SendSend AnyAny PaymentsPa                     With This Form yments)  )                                                                                                                                                                                                               With This Form 
                                                                                                                                                                                    
                                 FORFOR TAXTAX PURPOSESPURPOSE                                                               ONLY – DO NOT USE THIS FORM IF YOU ARE REQUIRED TO HOLD A S ONLY – DO NOT USE THIS FORM IF YOU ARE REQUIRED TO HOLD A 
                                                                                                                                                                   CHICAGOCHICAGO BUSINESSBUSINESS LICENSE   LICENSE 
                                                                                                                                                                                    
                                                            New Accounts Information Sheet - Sole Proprietor  New Accounts Information Sheet - Sole Proprietor  
                                    (T(This Form is not required if you currently or previously have held a City of Chicago Business license as a sole proprietor.)his Form is not required if you currently or previously have held a City of Chicago Business license as a sole proprietor.) 
                                                                                                                                                                                   
                                                                                                                          (Bold Faced items are required to begin the processing of your application) 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
1. What is your legal name, home address etc? 
 
                                               FIRST NAME                                                                              MIDDLE INIT                                      
 
                                                LAST NAME                                                                                                   JR./SR. 
 
   STREET NUMBER    DIR.                        STREET NAME                                           RD, AVE etc.        Suite/Floor 
 
                                                    CITY                                                                    ST                     ZIP CODE 
  
                                                                                                                                                                               /               / 20    
                                                                                                                                      BUSINESS START DATE               
 
                                                                                                                                                                                                                              /                                                                                                                                                                                  / 19         
                                                                                                                                                                                                    
                                                                                                                                                                                                               DATE OF BIRTH 
                                             -              --                                                             -                                      --                                                                                                                                                                                                                                                                                                                       
  
                             Phone Number                 
                                                                                                                                                                                                                                                                                                                                                                                                                
                                                                                                          .                                                                                                                                                                                                                                                                                                            
                                               Business / Contact E-Mail Address       
                                                            

2.     What is the Doing Business As (DBA) name (if not doing business under your own name)? * 
 
                  *(If different you must apply for an Assumed Name at 118 N. Clark St. Lower Level Chicago, IL 60602 (312) 603-5652) 
  
3. Illinois Business Tax (IBT) Number**                                                                                     -   
            
                             (Needed if goods are sold or if you have employees other than yourself on your payroll) 
             **If you do not have a current IBT# you may obtain one from the Ill. Dept. of Revenue at 100 W. Randolph St. (Lower Level) (217) 785-3707 
 
4. Describe your business’s activities?  Please mention all products or services you offer. 
 
     ________________________________________________________________________________________ 
 
      ________________________________________________________________________________________ 
 
     ________________________________________________________________________________________ 
 
5.  Do you employ 50 or more individuals whose work is located in Chicago       Yes      /       No          (circle one) 
 
6.  Do you rent out or lese tangible items which are used in Chicago     Yes      /      No                           (circle one) 
 
7. Who is the primary contact person for the organization? 
 
                                                                     FIRST NAME                                                                      MIDDLE INIT   
                                     
                                                                     LAST NAME                                                                                      JR./SR. 
  
8. What is the business site address where business transactions or public way use occur? 
 
   STREET NUMBER    DIR.                        STREET NAME                                           RD, AVE etc.        Suite/Floor 
 
                                                     CITY                                                                    ST                     ZIP CODE   
                        
                             -              --                                 -                                       --                                                                                                                                           -                                         --                            -                                         --                                                                        
                             Phone Number                                                                              FAX Number 
 
9. Do you own or rent the location where your business transactions or public way use occur? 
 
________ own 
 
_________ rent 
 
Note: If you rent your business location you may be required to supply a copy of your lease.             
 

10. What is your spouse’s legal name, home address etc (if applicable)? 
 
                                               FIRST NAME                                                                              MIDDLE INIT                                      
 
                                                LAST NAME                                                                                                   JR./SR. 
 
   STREET NUMBER    DIR.                        STREET NAME                                           RD, AVE etc.        Suite/Floor 
 
                                                    CITY                                                                    ST                     ZIP CODE 
  
                                -                                                                                        -                                                                                /                       / 19    
  
                          PHONE NUMBER                                                                                       DATE OF BIRTH 
                       
Note: If you are purchasing a business in the City of Chicago, you are required per section 3-4-140 of the Uniform Revenue 
Procedures Ordinance to file a Bulk Sales Notification.   
 
If you have any questions regarding this form please call 312-747-4747 or for TTY dial 312-742-1974.  Email this document  
when completed to RevenueDatabase@cityofchicago.org   
                                                                                                                                
                                                                                                                           Or you can fax your completed document to: 
                                                                                                                                 312-747-1890 
                                                                                                                                 Attn: Database Unit 
                                                                                                                                   
                                                                                                                           Or you may mail your completed document to: 
                                                                                                                                   
                                                                                                                               Chicago Department of Finance 
                                                                                                                                333 S. State Street Room 300 
                                                                                                                                 DePaul Center 
                                                                                                                                 Chicago, IL 60604 
                                                                                                                                 Attn: Database Unit