Postmark Date: 
                         2022 Business License Application 
                         Expiration Date: 12/31/2022 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  Businessnd                                                                                                                        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 10/27/2021                                                                                   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 2020 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                                                                                                            
                                                                                               Email if different than below: 
         6% Gaming Sales Tax 
         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 10/27/2021                                                                                       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 10/27/2021                                                                                  Page 3