APPLICATION FOR CERTIFICATE OF REGISTRATION 
                                               SALES, SERVICES, AND RENTAL TAX 
                                               KODIAK CITY CODE 3.08 SALES TAX 

MAIL TO:          CITY OF KODIAK- SALES TAX OFFICE 
                  710 MILL BAY ROAD, ROOM 211                           D NEW APPLICATION
                  P.O. BOX 1397 
                  KODIAK, ALASKA 99615                                  D UPDATED APPLICATION

PHONE: 907-486-8655 
FAX: 907-486-8600 

Date of Application:                           Account Number (Issued bv Citv): 
                                              I
Name of Business: 

Physical Address of 
Business in Kodiak:        # Street                       Citv                           State          Zip 

Mailing Address of 
Business:                  # Street  (PO Box)             Citv                           State          Zio 

Email:                                         Phone:                 Cell:                      Fax: 
                                              I
Name of Owner:                                                        Owner's Contact  Number: 
                                                                     I

Owner's Mailing Address:   # Street (PO Box)              City                           State          Zip 

Type of Business Activity: 

Date Business Started 
(In Kodiak)                                    Type Of Organization:  D Individual             ID Comoanv
Social Security Number                        I
(Individual) 
Employer Identification 
Number (EIN) 
                                               NAICSCode: ------                                  Line of Business Code: 
Alaska Business License                        Business Activity for the State of Alaska                --
Number:                                        Must Submit Code with or without Business License 

Drivers License Number &                                              Owner's Date of Birth: 
State of Owner:                                                                                   mm/dd/yyyy 
                      TO BE COMPLETED IF A PARTNERSHIP OR CORPORATION (Use additional sheet if needed) 

I. Name:                                       Title: 

Mailing                                        Physical 
Address:                                       Address:                                          Phone: 

2. Name:                                       Title: 

Mailing                                        Physical 
Address:                                       Address:                                          Phone: 

3. Name:                                       Title: 

Mailing                                        Physical 
Address:                                       Address:                                          Phone: 

                      I AGREE TO ABIDE BY THE CITY OF KODIAK CODE FOR SALES TAX SECTION 3.08 

OWNER'S                                                               DATE: 
SIGNATURE: 

REQUIRED RETURNS MUST BE SUBMITTED REGARDLESS IF SALES ARE MADE ON OR BEFORE THE DUE DATE TO 
A  VOID PENALTY AND INTEREST CHARGES.