Postmark Date: 
                          2023 Business License Application 
                          Expiration Date: 12/31/2023          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                        (Date started or Expected 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 

2 ndBusiness Physical Address (attach an additional page if necessary) 

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 12/13/2022                                                                                   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 12/13/2022                                                                                     Page 2 

SECTION 8: RESALE AND SALES TAX EXEMPTION CARD REQUEST (DMC 4.20.050) 
 ☐  Sales Tax Exemption   ☐   Non Profit [IRS 501c(3) or 501 c(4]           ☐  Government 
     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 12/13/2022                                                                                   Page 3