Finance Department, Sales Tax Office 
                                                                                                                               155 South Seward St, Juneau, AK 99801 
                                                                                    BUSINESS REGISTRATION FORM                      Ph (907) 586-52 5  Fax (907) 586-0365 1
                                                                                                                                        Sales.Tax.Office@Juneau.org 

                                                                                                   CBJ USE ONLY 
BP Property                                                                          Sales Tax 
Account No.                                                                          Account No.                              Date          Initials 

                                                     Is this a:  New Business (    )             Change in Ownership (    ) *Complete Previous Owner section below 
                                                     Business                                                                  AK Business 
                                                     Name                                                                      License No. 
                                                     Doing 
         Business                                    Business As 
                            Identification                             (Enter 2-digit code from 
                                                     Line of Business                                         Federal ID No. 
                                                                         AK Business License) 
                                                                                                 Sales Tax Contact Information 
                                                     Mailing Address 

                                                     City                                                            State              Zip 
                                                     Contact Name                                                    Contact 
                                                     and Title                                                       Phone No. 
                                                                                     Business Personal Property Contact Information 
                                                     Complete this section only if Property Tax Contact Information differs from Sales Tax Contact Information 
                                                     Mailing Address 
                            Contact Information 
                                                     City                                                            State              Zip 
                                                     Contact Name                                                    Contact 
                                                     and Title                                                       Phone No. 
                                                     Physical Location 
                                                     (Street Address) 
                                                                                                                                                             CBJ Use Only 
                                                     City                                                     State            Zip                           M    Q    Y 
                                                     Business Phone No.                                       Business Email: 
                                                     General Description of 
                                                     Business Activity 
                                                     Start Date of Business Activity in Juneau 
                            Other Business Info      Type of 
                                                                      Sole Proprietorship (    )  Partnership (    ) Corporation (    ) Other (    )______________ 
                                                     organization: 
                                                     Will this business be selling  Liquor  or   Marijuana?        Is it a Hotel/Motel or Bed & Breakfast? --

                                                     Previous Owner Name 

                                                     Previous Owner Address 
                                                Owner
                  *Previous                          City                                                            State              Zip 

Under penalty of unsworn falsification, I attest that to the best of my knowledge that the information 
provided on this application is true and correct. 

Signature                                                                                                                      Date 
If this business is a corporation, an officer or director of the corporation must sign this form. 

                                                                                                   Continued on the back of the form -                       Continued 
                                                                                                   Applicants must complete both sides. 

                                                    Individual Information is required on all owners of the business** 
                                    Last            First                                                              Middle 
                                    Name            Name                                                               Initial 
                                    Mailing Address 
                                    City            State                Zip 
                                    Street Address 
                                    City            State                Zip 
                  Owner Information Work Phone      Social Security No. 
                                    Home Phone      Driver’s License No.                                               State 
                                    Office or Title       Date of Birth 
                                                    Individual Information is required on all owners of the business** 
                                    Last            First                                                              Middle 
                                    Name            Name                                                               Initial 
                                    Mailing Address 
                                    City            State                Zip 
                                    Street Address 
                                    City            State                Zip 
                  Owner Information Work Phone      Social Security No. 
                                    Home Phone      Driver’s License No.                                               State 
                                    Office or Title       Date of Birth 
                                                    Individual Information is required on all owners of the business** 
                                    Last            First                                                              Middle 
                                    Name            Name                                                               Initial 
                                    Mailing Address 
                                    City            State                Zip 
                                    Street Address 
                                    City            State                Zip 
                  Owner Information Work Phone      Social Security No. 
                                    Home Phone      Driver’s License No.                                               State 
                                    Office or Title       Date of Birth 
                                                    Individual Information is required on all owners of the business** 
                                    Last            First                                                              Middle 
                                    Name            Name                                                               Initial 
                                    Mailing Address 
                                    City            State                Zip 
                                    Street Address 
                                    City            State                Zip 
                  Owner Information Work Phone      Social Security No. 
                                    Home Phone      Driver’s License No.                                               State 
                                    Office or Title       Date of Birth 
 
**Attach additional owner information if necessary. 
                                                                         i:\webpage\RegTable.doc 10/25/17