Application for Tax Certificate - City of Birmingham, Alabama

CITY OF BIRMINGHAM
APPLICATION FOR TAX CERTIFICATE

COMPLETE AND RETURN THIS FORM TO:
City of Birmingham-Revenue Division
710 North 20th Street-Room TL 100
Birmingham, AL 35203
(205) 254-2198 Office
(205) 254-2963 Fax
www.informationbirmingham.com

The information that you provide in this application is protected by the confidentiality provisions outlined in Ordinance No. 97-183, “The Business License Code of the City of Birmingham”, Article II, Section 14. Please type or print. This application should be completed fully to avoid delays in processing.

Section 1 – WHAT WOULD YOU LIKE TO DO?

Section 2 – LEGAL NAME AND MAILING ADDRESS to which tax forms are to be sent:

(Note: If mailing address is a post office box, the street address of the business must also be indicated.)

Full Legal Name

Attention:

Address

City State Zip Code

Area Code and Phone Number

Area Code and Fax Number

Name of Contact Person

E-Mail Website Address

Section 3 – TRADE NAME AND LOCATION ADDRESS of office in Birmingham. If you are registering more than one location, please see reverse side of this form. (Important Note: All business locations are subject to zoning approval.)

Please select: Commercial Establishment    Private Residence    No Physical Birmingham Location

Trade (d/b/a) Name

Attention:

Address

City State Zip Code

Area Code and Phone Number of Business Location

Area Code and Fax Number of Business Location

Name of Contact Person at Business Location

E-Mail Website Address

Section 4 – CHANGE OF OWNERSHIP resulting from merger, purchase or acquisition of an existing business. If applicable, this section MUST be completed.

Former Owner Birmingham Taxpayer ID Number

Trade (d/b/a) Name

Mailing Address of Former Owner

Address(es) of Former Location(s)

Area Code and Phone Number of Former Owner

Section 5 – TYPE OF OWNERSHIP

Please indicate the form of organization. NOTE: Please refer to the accompanying “General Information for Preparing an Application for Tax Certificate Form” instruction sheet for a listing of supplemental documentation to be included with this application.

Section 6 – TYPE OF BUSINESS

Please indicate the principal business activity category.

Section 7 – PRINCIPAL BUSINESS ACTIVITY AND PRODUCT

You should indicate the one business activity that accounts for the largest percentage of gross income. State the broad field of business activity as well as the product or service.

Activity Product

Section 8 – FEDERAL TAX ID NUMBER / NUMBER OF EMPLOYEES

Federal ID Tax Number Number of Employees in Birmingham (Required)

Section 9 – COMMENCEMENT OF BUSINESS ACTIVITY

Enter Date Business Activity Will Begin in Birmingham: Month Day Year

Enter Date City of Birmingham Taxpayer Identification Number Applied For: Month Day Year

Section 10 – TAX LIABILITIES Check the taxes for which you are liable.

Section 11 – OWNER, PARTNERS, MEMBERS, OR CORPORATE OFFICERS

This information REQUIRED. (Attach additional sheets if necessary.)

Section 12 – CORPORATE RESIDENT AGENT OR LOCAL MANAGER

Name

Address of Residence

City State Zip Code

Area Code and Phone Number of Residence

Section 13 – STATEMENT OF ACKNOWLEDGEMENT AND ACCEPTANCE OF CONDITIONS – Please read carefully, then sign.

I declare, under the penalty of making a false declaration, that I am authorized to complete this form and to the best of my knowledge and belief all questions answered are true, correct, and complete statements, made in good faith. I understand and agree that the granting of this license requires my compliance with all applicable City of Birmingham Tax Code provisions, and state laws, as well as with all conditions set forth in any and all applicable City of Birmingham Laws, Ordinances, Rules and Regulations, and that any failure or refusal to comply with said laws, ordinances, rules and regulations may result in the revocation of any license issued pursuant to this application. I also understand that disclosure of any false or misleading information will result in automatic denial of any license issued pursuant to this application, or in the revocation of the license if such has already been issued. I understand that it is unlawful for any person to commence or engage in any business, vocation, occupation or profession, who is not otherwise exempt therefrom under the provisions of the City of Birmingham Business License Tax Code (Ordinance No. 97-183), without first having procured a license therefor, and that it is unlawful for any person to continue in any business, vocation, occupation, or profession after the expiration of a license previously issued, without obtaining a new license. I further understand that it is unlawful for any person to engage in or to continue in any business, vocation, occupation, or profession at any location within the corporate limits of the City of Birmingham without approval from the City of Birmingham Department of Planning, Engineering, and Permits (Zoning Division).

CITY OFFICE USE ONLY – Location

Section 14 – ADDITIONAL TAXABLE LOCATIONS