TOWN OF LIVINGSTON
OCCUPATIONAL LICENSE TAX APPLICATION
(The tax is due January 1 for existing businesses and is delinquent after the last day of February.)
1. Date of Return / / (MONTH, DAY, YEAR)
2. New Business Renewal—PROVIDE PRIOR YEAR’S LICENSE NUMBER:
3. FEDERAL EMPLOYER ID NUMBER:
4. LA SALES TAX NUMBER:
5. LOCAL SALES TAX NUMBER:
6A. TAXPAYER NAME B. TELEPHONE NUMBER
C. TRADE NAME
D. MAILING ADDRESS, CITY, STATE, ZIP CODE
E. PHYSICAL LOCATION, STREET ADDRESS, CITY, STATE, ZIP CODE
7. Location of Accounting Records:
d
e
8.
Type of Business:
Individual
Partnership
Corporation
Governmental Non-profit other (specify)
9. Provide information on owner(s) below. If corporation or partnership, provide information for officers or partners.
For corporation, provide state of incorporation:
NAME
TITLE
SOCIAL SECURITY #
RESIDENT ADDRESS
TELEPHONE #
NAME
TITLE
SOCIAL SECURITY #
RESIDENT ADDRESS
TELEPHONE #
NAME
TITLE
SOCIAL SECURITY #
RESIDENT ADDRESS
TELEPHONE #
10. Name and address of agent for service of process
11. Nature of Business-description of sales or activity.
I affirm that the information given on this application and the attached schedules is true and correct.
12. SIGNATURE OF APPLICANT TITLE
SIGNATURE OF PREPARER IF DIFFERENT FROM ABOVE