Postmark Date: 
                      2024 Business License Application 
                      Expiration Date: 12/31/2024        Fee: $50 (Section 7) 
                                                      
                                                 City of Dillingham 
                                                 PO Box 889 
                                           Dillingham, AK 99576 
                             Phone: 907-842-5211  Fax: 907-842-5691 
                                           taxes@dillinghamak.us 
DMC 4.16, in order to operate a business within the city it is necessary to obtain a Dillingham business license.  “Business” 
means:  
  A. A person (as defined in Section 4.20.020), partnership, corporation or company of any sort providing goods or 
        services within the city for a profit, unless the goods or services consist entirely of casual or isolated sales (as defined 
        in Section 4.20.050) 
  B.    A person, partnership, corporation or company of any sort providing the service of operating a taxicab or vehicle-for-
        hire and required to have a business license and remit sales tax regardless of the amount of sales. 

Application is for:☐  New Business  __________________(Expected date to start operating in Dillingham) 
               ☐  Renewal                        ☐Change in Ownership 
SECTION 1: OWNERSHIP TYPE (Check Only One) 
☐  Corporation       ☐  Partnership                 ☐  Limited Liability Company (LLC)     ☐  Other: ________________ 

☐  Individual / Sole Proprietor            ☐  Non Profit     [IRS 501c(3) or 501c(4) Documents required] 

SECTION 2: BUSINESS CONTACT AND LOCATION INFORMATION 
Business Name                                                       Additional DBA 

Business Mailing Address                                                                   City 
 
State                                      Zip Code                 Phone                  Fax 

Business Contact                                                    Business Email 

Business Physical Address (no PO Boxes) 

City                                       State             Zip Code                      Federal Tax ID or SSN 

Business Location is                       If outside City limits, is your business 
  ☐  Inside City Limits                          ☐  Coming into the City to provide services or sell products 
                                                 ☐  Online Vendor 
                                                 ☐  Temporary vendor located at ______________________ 

SECTION 3: CHANGE IN OWNERSHIP (if needed) 
Previous owner name                                                 Previous Owner Address 

City                                       State             Zip Code                      Phone 

SECTION 4: OWNER/REGISTERED AGENT INFORMATION 
      Name                                            Driver’s License              Date of Birth 
 
1     Mailing Address                                                                      Social Security Number 

      City                                 State                    Zip Code                    Phone 
                   
Business License Application Rev 11/8/2023                                                                         Page 1 

SECTION 4: OWNER/REGISTERED AGENT INFORMATION (Cont.) 
      Name                                        Driver’s License         Date of Birth 
       
2                      
      Mailing Address                                                                                   Social Security Number 

      City                                 State            Zip Code                                    Phone 

      Name                                        Driver’s License         Date of Birth 
 
3     Mailing Address                                                                                   Social Security Number 

      City                                 State            Zip Code                                    Phone 
      Name                                        Driver’s License         Date of Birth 
 
4 
      Mailing Address                                                                                   Social Security Number 

      City                                 State            Zip Code                                    Phone 

SECTION 5: BUSINESS DESCRIPTION AND LICENSING 
Briefly Describe Business Conducted                                        Past Dillingham BL No.                               
                                                                           Expiration Date                                      
Other Business Licenses and I.D’s (Any required license must be issued before a City license can be issued) 
             State of Alaska No.                                           Expiration Date                                  
             Occupational No.                                              Expiration Date                                  
                      Required if working in a specialty occupation. Must be 2023 expiration or greater 
             Permit No.                                                    Expiration Date                                  
SECTION 6: SALES TAX COLLECTION   
DMC 4.20.090 
  ☐  Request Authority to Collect Sales Tax (one per physical location needed)________________ 
DMC 4.20.115                                                Select preferred method to receive sales tax packet: 
Reporting Frequency:                                         ☐     Already received sales tax pack 
  ☐  Monthly                                                 ☐     Please mail sales tax packet  
  ☐  Quarterly, must be remitting less than $100 per month   ☐     Please email sales tax packet 
Remittance Type:                                             
  ☐  6% Sales Tax                                                                                                            
  ☐  6% Gaming Sales Tax                                                                   Email if different than below: 
  ☐  10% Alcohol Tax 
  ☐  10% Lodging Tax 
Contact information for the person or service preparing sales tax filings: 

Name                                                         Title 

Email                                                        Phone 

SECTION 7: BUSINESS LICENSE FEE AND PENALTIES 

Check all that apply: 
  ☐  $50 Business License Application Fee 
  ☐  Non-profit Fee Waiver (business license fee ONLY) 
   
  ☐  $75 Late Fee (applies to renewals received after January 1 or new business who fail to apply within 45 days of start 
                 This is in ADDITION to the $50 Business License Application Fee for a total of $125 

Business License Application Rev 11/8/2023                                                                                   Page 2 

  SECTION 8: RESALE AND SALES TAX EXEMPTION CARD REQUEST (DMC 4.20.050) 
   ☐   Non Profit Sales Tax Exemption [IRS 501c(3) or 501 c(4] ☐  Government Sales Tax Exemption 
       Sales, services, and rentals to organizations that have obtained a 501c(3) or 501 c(4) exemption certificate 
       from the Internal Revenue Service, and which are made in the normal conduct of activity, but not to 
       individual members or employees thereof for their own personal consumption, use or accommodation; the 
       exemption does not apply where such organizations are engaged in business for profit or savings, or 
       competing with other persons engaged in similar business: 
        
   ☐   Resale  
       Sales of goods to a wholesaler, retailer, or other purchaser if such purchaser resells the same good, in the 
       same or altered form, and the resold goods will not be exempt from the tax levied under this chapter.  
   
   To obtain the exemption provided for in this subsection, the purchaser shall display or provide to the seller at 
   the time of the sale a copy of the exemption card. If the purchaser buys goods for personal use at the same time 
   of the sale only the goods that are sales tax exempt or for resale (as described above) are exempt. Supplies, 
   services, tools, repair serviced, equipment or other goods or services purchased to support a business but not 
   for resale are not exempt.  
  SECTION 9: AUTHORIZING SIGNATURE 
  I, the undersigned applicant, do swear (or affirm) that the foregoing statements are true, full and correct to the best of my 
  knowledge and belief.  I also agree to comply with all applicable city ordinances regarding conduct of business, sales tax 
  reporting and use of sales tax exemption/resale. Should anything change during the calendar year the city will be notified. 
   
  ______________________________________________________ 
  Signature of Applicant or Authorized Agent  
  ______________________________________________________ 
  Printed name and title 
  ____________________________________ 
  Date 
 
 FINANCE DEPARTMENT USE ONLY 
  
 This business has been   ☐  Approved    ☐  Denied    ☐  N/A    a business license for the period beginning_____________ 
 This business has been   ☐  Approved    ☐  Denied    ☐  N/A    the authority to collect sales tax for each location. (section 6) 
 This business has been   ☐  Approved    ☐  Denied    ☐  N/A    a sales tax exemption card. (section 8) 
 This business has been   ☐  Approved    ☐  Denied    ☐  N/A    a resale exemption card (section 8) 
 Additional notes or comments; 
  
 Finance Director                                       Date 
  
 Finance Department Use Only                                      ☐  Visa       ☐  Cash 
 Fee Paid $ ________________        Receipt No. ___________________   Check No. __________________ 
 
Business License Application Rev 11/8/2023                                                                                      Page 3