White 226 Original Canary 226 Auditor Goldenrod - Applicant CITY OF MONTEREY PARK320 West Newmark Avenue, Monterey Park, CA 91754 Attn: Bus. License Dept. 225 (626)307-1338 225 Fax (626) 307-0753 BUSINESS LICENSE APPLICATIONNEW APPLICATION Please CHANGE OF OWNER Check One CHANGE OF ADDRESS CHANGE OF BUSINESS NAME HOME OCCUPATION 225OFFICIAL USE ONLY 225 Business Name LICENSE NO. Business Location LICENSE FEE $ (Not P.O. Box) PENALTY TOTAL FEE $ CityState Zip DATE PAID Mailing Address CHECK NO CASH (If Different) BY: CityState Zip Bus. Phone ( ) Bus. Fax ( ) E-Mail Address Ownership: Corporation Ltd Liability Corp Partnership Sole Proprietor Trust Start Date Description of Business Business Types: Retailers Wholesalers/Manufacturers Professionals Services Home Occupations Residential/Commercial Rental State Lic. No. License Type Expiration Date Resale No. Federal I. D. No. State I. D. No. Enter below names of Owners, Partners, or Corporate Officers -Use additional sheets as necessary Owner Name Title Phone( ) Home Address Cell Phone ( ) City State Zip Social Security No. Drivers License No. Owner Name Title Phone( ) Home Address Cell Phone ( ) City State Zip Social Security No. Drivers License No. In case of emergency, please contact: Name Title Phone ( ) Address Cell Phone ( ) Vehicle Insurance Information Company Name Policy No. Expiration Date PLEASE COMPLETE THE FOLLOWING INFORMATION No. of Owner/Professionals \ No. of Non-Prof. Employees \ No. of Vehicles \ No. of Units \ No. of Coin Operated (Service) Machines \NOTE: Sales or use tax may apply to your business activities. You may seek written advice regarding the application of tax to your particular business by writing to the nearest State Board of Equalization office. For general information, please call the Board of Equalization at 1-800-400-7115. No. of Game Machines \ / declare under penalty of making a false certification that the foregoing information is true and correct to the best of my knowledge and belief. Date: Title: Signature: RETURN ENTIRE APPLICATION FORM TO ABOVE ADDRESS AND MAKE CHECK PAYABLE TO THE CITY OF MONTEREY PARK PLEASE CALCULATE AMOUNT DUE BY ENTERING INFORMATION IN BOXES BELOW AND SIGN. $ $ $ $ $ $ $ $ $ $ $ .00 Gross Receipts Base Fee (includes 1 owner) Professional/ Add'l Owner Fee Non-Professional Employee Fee Units Fee Coin Operated Machine Fee Vehicle/Delivery Fee Tobacco Fee B.I.D. Fee Penalty Fee State Disability Access Fee TOTAL DUE $ Thank you for doing business in the City of Monterey Park! American LegalNet, Inc. www.FormsWorkFlow.com