Std License Form v1 Nov 2006 
                                CITY OF HELENA , ALABAMA BUSINESS APPLICATION 
                 The City Does Impose the Business License Tax in its Police Jurisdiction 
                                                               (CONFIDENTIAL) 
                                                                                                 Applicant Complete This Box 
        Complete and Mail/Fax To:                                                                FEIN                  ___________________ 

                                                                                                 ST of ALA TAX #   ___________________ 
                                                                                                 
           CITY OF HELENA                                                                        FORM OF OWNERSHIP (Check One) 
           PO BOX 613                                                                                                 
        HELENA, AL 35080-0613                                                                     Sole Prop. _____    Partnership ______ 
                                                                                                  Corp.  _____       Prof Assoc  ______ 
  (205) 663-2161         Fax (205) 663-9276                                                       LLC  ______        Other ___________ 
                                                             
       Please Print or Type 
                      SEE REVERSE SIDE FOR INSTRUCTIONS AND FURTHER INFORMATION 
Application Type :  New ____    Owner Change ____    Name Change _____    Location Change _____ 
 
Legal Business Name :  ___________________________________________________________________________________________ 
Trade Name: (If different from above) _________________________________________________________________________________ 

Business Activities:(Brief description- Retail clothing sales, wholesale food sales, rental of industrial equip., computer consulting, etc) 

________________________________________________________________________________________________________________ 

Physical Address:       ___________________________________________________________________________________________
   (Street)                                                  (City)                                         (State)             (Zip) 
 
Mailing Address: 
   (Street)                                                  (City)                                         (State)             (Zip) 
Telephone:              ___________________________________________________________________________________________
                                 (Business)                  (Fax)                                          (Home Phone)
 
Name & Phone # for Contact Person __________________________________________________(____)__________________________ 
Email address for contact:          ___________________________________________________ 
 
List Following for Owner(s), Partners, or Officers (Attach separate sheet if necessary) 
Name  Residence Address     SSN (if not publicly traded co.)                                                            Title 
 
Date Business Activity Initiated or Proposed in Helena:___________________  # of Employees in Helena _________________ 
 
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 
 
ACCOUNT ID # __________________             LICENSE CODE _______________________   AMOUNT $_________________
   REVIEWED BY: ___________________ 
 
PHYSICAL LOCATION:  †   CITY                          † POLICE JURISDICTION                      † OUTSIDE CORP LIMITS & PJ 
 
ZONING CLASSIFICATION: ______________  BUILDING APPROVAL:  †  YES  †  NO  † N/A                  FIRE CODE  † 
 
Tax Types:       †  Sales/Seller’s Use      †   Consumer Use                  †   Rental/Lease        †   Alcohol                   
 
                 †   Tobacco                     †   Gas/Motor Fuel        †   Business License 
 
Tax Filing Frequency:       †    Monthly            †    Quarterly               †    Annual               †      Occasional 
  
Business Type:     †   Retail         †   Wholesale        †  Building Contractor         †  Service           †  Professional         
                      †   Manufacturer                †  Rental                               † Other _________________________ 
 

Std License Form v1 Nov 2006 
                                              
   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) 
 
⇒ AFTER COMPLETING THIS FORM IT CAN BE MAILED, SENT BY FAX,OR WHERE POSSIBLE                                            , 
  SENT BY ELECTRONIC MAIL TO THE MUNICIPALITY. 
 
⇒ UPON RECEIPT OF THE COMPLETED FORM, THE MUNICIPALITY WILL PROVIDE ANY 
  ADDITIONAL FORMS AND INFORMATION REGARDING OTHER SPECIFIC REQUIREMENTS TO 
  YOU IN ORDER TO COMPLETE THE LICENSING PROCESS. 
 
BEGINNING JANUARY 2008 
ALL LICENSE RENEWALS ARE DUE JANUARY 1 AND DELINQUENT AFTER JANUARY 31 WITH THE 
FOLLOWING EXCEPTIONS: 
 
         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 MORE DETAILED EXPLANATION.