CITY OF DAPHNE, ALABAMA BUSINESS TAX IDENTIFICATION APPLICATION 
                                                                        (CONFIDENTIAL)  
         Complete and Mail                                                                                       Applicant Complete This Box 
                                                                                                       FedID#_____________________________ 
         City of DAPHNE                                                                                 ST of Ala Tax #______________________ 
         P.O. Drawer 1047                                    TAXPAYER ID#_____________                      Form of Ownership (Check One) 
         DAPHNE, AL 36526                                                                                   Sole Proprietor                       Partnership 
                                                                                                            Corporation                            Professional Assoc. 
                                                                        Please Print or Type                LLC                                         Other ____________                      
  Phone: (251) 621-6613    Fax: (251)621-6904                SEE REVERSE SIDE FOR INSTRUCTIONS                                                                                                                                                                                                                                                                          
                                                               AND FURTHER INFORMATION 
 
Date Business Activity Initiated/Proposed in DAPHNE: _________________________DATE OF APPLICATION:_________________________ 
                                                                          
APPLICATION TYPE:         NEW               RENEWAL                OWNER CHANGE                NAME CHANGE             LOCATION CHANGE 
 
Legal Business Name: _____________________________________________________________________________________________ 
 
Trade Name: (If different from above)______________________________________________________________________  
 
Anticipated Gross Revenue from start date through December 31st: $_____________________________________________ 
 
Deliveries via common carrier (ONLY):      YES         NO               Physical presence in Daphne (i.e. Sales/Service):      YES         NO          
 
Business Activities: (Brief desc. - example. retail clothing sales, wholesale food sales, rental of industrial equip., carpentry contractor, etc.) 
 
_________________________________________________________________________________________________________________ 
 
Physical Address:  __________________________________________________________________________________________________ 
                                (Street)                                                      (City)                                                              (State)                                       (Zip) 
 
Mailing Address:   __________________________________________________________________________________________________ 
                                (Street)                                                      (City)                                                              (State)                                        (Zip) 
 
Telephone: _______________________________________________________________________________________________________                                            
                               ( Business)                                          (Cell)                                                (Home)                                         (Fax) 
 
Email:                                                     
 
List Names of Owner(s), Partners, or Officers (Attach separate sheet if necessary) 
         Name                                    Driver License #/State   SSN                                                   Title 
_______________________________________________________________________________________________
_______________________________________________________________________________________________ 
_______________________________________________________________________________________________ 
 
This application has been examined by me and is, to the best of my knowledge, a true and complete representation of the above named entity, 
and person(s) listed. 
 
Date __________________   Signature ______________________________________________      Title ____________________________                                                                                                                                                     

                                                             THIS AREA FOR MUNICIPAL USE ONLY 
  
 DATE: ________________PAID:_________________CHECK/CASH_________________BY:_______________BATCH#_____________  
  
  Physical Location:                          Tax Types:                       TAX FILING FREQUENCY:         BUSINESS TYPE: 
        
       CITY/COMMERCIAL (001)                     SALES/SELLER'S USE               ANNUAL                         RETAIL 
       CITY/RESIDENTIAL (003)                    CONSUMER USE                      QUARTERLY                     WHOLESALE 
       PJ  (N/A)                                 RENTAL                            MONTHLY                       BUILDING CONTRACTOR 
       BALDWIN CO (010)                          LODGINGS                          OTHER______________            ___________________ 
       MOBILE CO (008)                           LOCAL LIQUOR                                                    SERVICE  
       ALABAMA (999)                             BEER/WINE                                                       PROFESSIONAL 
       OUT OF STATE (009)                        TOBACCO                                                         MANUFACTURER 
                                                 GAS/MOTOR FUEL                                                  RENTAL 
                                                                                                                NAICS CODE 
                                                                                                                  ____________________ 
 APPROVAL (BIN) COMPLETE:      YES         NO                                                                     ____________________ 
 APPLICATION FOR HOME BUSINESS COMPLETE:       YES         NO                                                     ____________________ 

     PLEASE READ THE FOLLOWING INFORMATION CONCERNING THE COMPLETION OF THIS FORM 
PLEASE COMPLETE ALL AREAS OF THE FORM EXCEPT FOR THE SHADED AREA AT THE BOTTOM. 

FORM SHOULD BE TYPED OR PRINTED LEGIBLY 

FORM SHOULD BE DATED AND SIGNED BY AN OWNER, PARTNER, OR OFFICER OF THE BUSINESS 

FORM WILL INITIATE THE PROCESS FOR REGISTERING YOUR BUSINESS WITH THE MUNICIPALITY 
 
==>IF YOUR BUSINESS WILL HAVE A PHYSICAL LOCATION WITHIN THE MUNICIPALITY, PLEASE USE THAT 
        ADDRESS ON THE FRONT OF THIS FORM. (Complete separate forms for each physical location in the 
        City.) 
 
==>  UPON RECEIPT OF THE COMPLETED FORM, THE MUNICIPALITY WILL PROVIDE ANY ADDITONAL 
        FORMS AND INFORMATION REGARDING OTHER SPECIFIC REQUIREMENTS TO YOU IN ORDER TO 
        COMPLETE THE LICENSING PROCESS. 
 
ALL LICENSE RENEWALS ARE DUE JANUARY 1 AND DELINQUENT AFTER JANUARY 31, WITH THE 
FOLLOWING EXCEPTION: 
                
               INSURANCE COMPANY LICENSE: DUE JANUARY 1, DELINQUENT AFTER MARCH 1 
 
THIS FORM IS INTENDED AS A SIMPLIFIED, STANDARD MECHANISM FOR BUSINESSES TO INITIATE 
CONTACT WITH A MUNICIPALITY CONCERNING THEIR ACTIVITIES WITHIN THAT CITY. A BUSINESS 
LICENSE WILL BE REQUIRED PRIOR TO ENGAGING IN BUSINESS. IF A BUSINESS INTENDS TO MAINTAIN 
A PHYSICAL LOCATION WITHIN THE CITY, THERE ARE NORMALLY ZONING AND BUILDING CODE 
APPROVALS REQUIRED PRIOR TO THE ISSUANCE OF A LICENSE. 
 
IN CERTAIN INSTANCES, A BUSINESS MAY SIMPLY BE REQUIRED TO REGISTER WITH THE CITY TO 
CREATE A MECHANISM FOR THE REPORTING AND PAYMENT OF ANY TAX LIABILITIES. IF THAT IS THE 
CASE, YOU WILL BE PROVIDED THE MATERIALS FOR THAT REGISTRATION PROCESS. 
 
THE COMPLETION AND SUBMISSION OF THIS FORM DOES NOT GUARANTEE THE APPROVAL OR 
SUBSEQUENT ISSUANCE OF A LICENSE TO DO BUSINESS. ANY PREREQUISITES FOR A PARTICULAR TYPE 
AND LOCATION OF THE BUSINESS MUST BE SATISFIED PRIOR TO LICENSING. 
  
SHOULD THERE BE ANY QUESTIONS CONCERNING THE COMPLETION OF THIS FORM OR THE LICENSING 
AND/OR REGISTRATION PROCESS, PLEASE CALL THE NUMBER ON THE FRONT OF THIS FORM TO OBTAIN 
A MORE DETAILED EXPLANATION.