CITY USE ONLY
New Renewal
Date Received:
Receipt Number:
P.O. Box 46
Kotzebue, Alaska 99752
Phone: (907) 442-3401
Fax: (907) 442-3742

APPLICATION FOR SALES TAX LICENSE
Authority: Kotzebue Municipal Code §3.20

“No sales tax license may be issued to or renewed for a person owing a judgment, delinquent taxes
or a utility bill to the city […]” KMC 3.20.170(C.).)

SECTION I ENTITY TYPE: Please select one.
__ Individual/Sole Proprietor __ Limited Liability Company __ Non-Profit (IRS 501c verification required.)
__ Corporation __ Partnership
Partnership: (Please attach a list of partner names if there are more than two partners.)

Printed Name: _______________________________________________ Title: __________________________
Printed Name: _______________________________________________ Title: __________________________
SECTION II BUSINESS INFORMATION: Pursuant to KMC §3.20
Business Name: __________________________________________________________________________________
Business Address: __________________________________________________________________________________
Mailing Address Physical Address
Federal Tax ID Number: __________ Alaska Business License Number: __________ NAICS Code: ________
Submit a copy of your Alaska business license as proof of compliance with applicable state and federal licensing requirements.
Describe nature of business: _________________________________________________________________________
Is the business seasonal? Yes___ No__ If yes, business is conducted from: __________________________________
SECTION III PERSON RESPONSIBLE FOR FILING:
Name: ____________________________ Title: ___________________ Phone Number: ____________________

SECTION IV SIGNATURE AND DISCLOSURE:
I do declare, under penalties of perjury, that this application has been examined by me. To the best of my knowledge and belief it is a true, correct and complete application.

______________________________________ ____________________________________ ________________
Printed Name of Owner or Agent Signature of Owner or Agent Date
_____________________________________ ____________________________________ ________________
Printed Name of Owner or Agent Signature of Owner or Agent Date

Valid: January 1, 2021 through December 31, 2021
Renewed annually upon payment of a $50 fee and completion of renewal form.

Revised: November 20, 2020

---

Document checksum: 809133295

Document converted by WebSite-Watcher.
(Plugin #1/1.38/3.1.0/1.0)