Office Use Only 
                                                                                     Account Number 
                                             CITY OF PUEBLO 
                             FINANCE DEPARTMENT/SALES TAX DIVISION 
                                         P.O. BOX 1427, PUEBLO, CO 81002 
                                         1 CITY HALL PL, PUEBLO, CO  81003           N   U   AC   NC   OC 
                                   PHONE (719) 553-2659    FAX (719) 553-2657 
                                   WWW.PUEBLO.US  Email: salestax@pueblo.us 

□ SALES AND USE ($50.00)                 □ USE TAX ($50.00)                         □ EXEMPT (No Fee)
                                                                                            Government  
                                                                                 ( Provide support of government status) 
OTHER LICENSES REQUIRED 
                      MAKE CHECK OR MONEY ORDER PAYABLE TO THE “CITY OF PUEBLO” 
        (A SEPARATE APPLICATION IS REQUIRED FOR EACH BUSINESS LOCATION BY ORDINANCE) 

IMPORTANT: PLEASE ANSWER ALL QUESTIONS COMPLETELY – FAILURE TO DO SO MAY DELAY THE PROCESS. 
THIS APPLICATION AND YOUR ANSWERS TO THE QUESTIONS ARE SUBJECT TO THE COLORADO OPEN RECORDS 
ACT, C.R.S. § 24-72-200.1 ET SEQ., (“CORA”) AND MAY BE AVAILABLE FOR PUBLIC DISCLOSURE. IF ANY OF THIS 
INFORMATION IS CONSIDERED CONFIDENTIAL AND SUBJECT TO A CORA EXCEPTION, PLEASE INDICATE THAT BY 
WRITING “CONFIDENTIAL” NEXT TO THE ANSWER. 

1. Business Name ______________________________________________ Business Phone
                                                                           Fax Number

   If Corporation, please list corporate name

2. Business Address
                      Street                               City               State          Zip Code 
3. Local Representative or Manager:
                             Name – Title                                     Phone Number 

IMPORTANT: THE ANSWERS TO THE REMAINING QUESTIONS ON THIS APPLICATION WILL BE CONSIDERED TRADE 
SECRETS AND  CONFIDENTIAL COMMERCIAL  AND FINANCIAL INFORMATION NOT NORMALLY SUBJECT  TO 
PUBLIC DISCLOSURE PURSUANT  TO  C.R.S. § 24-72-204(3)(a)(IV).  IF YOU WOULD LIKE ANY  OF THE FOLLOWING 
INFORMATION TO BE PUBLICLY AVAILABLE, PLEASE INDICATE THAT BY WRITING “NOT CONFIDENTIAL” OR “NC” 
NEXT TO THE ANSWER.   

        Local Representative or Manager: 
                                 Residence Address 

4. Contact Person
                      Name                                                    Phone Number 
5. E-mail Address

6. Where do you want tax returns mailed?
                                         Name              Address                  City & State          Zip 

7.  Type of Ownership □ Sole Proprietor  *    □ Partnership     □ Corporation*                       □ LLC*
Required for licensing:  Current Driver’s License for Sole Proprietor ONLY, Proof of Corporation LLC, or Partnership to include 
                   Certificate of Inc., Articles of Inc. and/or By-Laws and all other documentation. 

   Name of all principal owners or officers: 
   Name               Home Address       City, State & Zip Date of Birth            Home Phone               Title 

A. 
B. 
C. 

                      ADDITIONAL INFORMATION REQUIRED ON BACK 

 If corporation outside the State of Colorado, list registered agent in Colorado, address and phone number: 

8. Name of business bank

9. Specify nature of business

10. List other City of Pueblo licenses held

11. Landlord of business address
                                Name              Address                                   Phone Number 

12. Accountant or Bookkeeper
                                Name              Address                                   Phone Number 

13. Location of Records:  □ Mailing Address  □ Business Address

                          □ Other (please specify)

14. Date business began in Pueblo _____________  Date of Change (i.e. address, name)

15. If business purchased, please list date of purchase and former owner

16. Did you purchase any business furniture, equipment or supplies from previous owner, from other individuals
 or vendors located outside the City of Pueblo, which you did not pay City of Pueblo sales tax?

 A. If yes, use tax is due to the City of Pueblo within ten (10) days.  Use Tax Return given

 B. If leasing, the equipment use tax is due on the monthly tax.

 I hereby certify that the statements made herein are true and correct to the best of my knowledge and that I         
have read and understand the City of Pueblo ordinances pertaining to the operation of my business. 

Signature                                               Title & Date 

                                  ***ADDENDUM*** 

PLEASE ANSWER THE FOLLOWING QUESTIONS AND RETURN THEM WITH YOUR APPLICATION. 
YOUR STATUS AS A MARIJUANA BUSINESS, LIQUOR RETAILER, OR TOBACCO PRODUCT RETAILER WILL 
BE PUBLICY AVAILABLE AND SUBJECT TO DISCLOSURE UNDER CORA. 

 Will this business be involved in MEDICAL MARIJUANA consumption, dispensary, cultivation, or other 
 associated use?  
    Yes   No

 Will this business be involved in RETAIL MARIJUANA consumption, dispensary, cultivation, or other 
 associated use?  
    Yes   No

 Will this business be involved in LIQUOR sales? 
    Yes   No

Do you plan to sell any TOBACCO products?  Tobacco product includes: (1) Any product that contains tobacco or 
nicotine or is made or derived from tobacco that is intended for human consumption or is likely to be consumed, 
ingested, smoked, inhaled, placed in oral or nasal cavities, or applied to the skin of an individual, including but not 
limited to, a cigarette, a cigar, pipe tobacco, chewing tobacco, snuff, or snus; or (2) Any device that can be used to 
deliver nicotine or tobacco to the person using the device, including but not limited to an electronic cigarette, cigar, 
cigarillo or pipe; or (3) Any component, part, accessory or associated tobacco paraphernalia of a tobacco product 
whether sold separately or not. However, the term tobacco product does not include: (A) Any product specifically 
approved by the United States Food and Drug Administration for use in reducing, treating or eliminating nicotine or 
tobacco dependence, or for other medical purposes, when such product is being marketed and sold solely for such an 
approved purpose; or (B) Any product that contains marijuana. 

            I AM CURRENTLY SELLING TOBACCO PRODUCTS AS DESCRIBED ABOVE 

            I DO PLAN TO SELL TOBACCO PRODUCTS AS DESCRIBED ABOVE 

            I DO NOT PLAN ON SELLING TOBACCO PRODUCTS AS DESCRIBED ABOVE 

IF YOU WOULD LIKE MORE INFORMATION OR IF YOU WOULD LIKE TO OBTAIN A TOBACCO PRODUCT 
RETAILER LICENSE, PLEASE CONTACT THE CITY CLERK’S OFFICE @ 719-553-2669. THANK YOU. 

 I hereby certify that the statements made herein are true and correct to the best of my knowledge and that I 
have read and understand the City of Pueblo ordinances pertaining to the operation of my business. 

Signature                                          Title & Date