Nevada State Business License ROSS MILLER Secretary of State 202 North Carson Street Carson City, Nevada 89701-4201 (775) 684-5708 Website: www.nvsos.gov Sole Proprietor Application Online application is also available at www.nvsos.gov USE BLACK INK ONLY - DO NOT HIGHLIGHT PRINT LEGIBLY OR TYPE ALL INFORMATION ABOVE SPACE IS FOR OFFICE USE ONLY Completing this form DOES NOT relieve you of any statutory or regulatory requirements relating to your business. You may be required to complete a Nevada Business Registration form with the Nevada Department of Taxation and Department of Employment, Training and Rehabilitation. Please check with these and other state/local government agencies for additional licensing requirements. * Asterisks indicate required information. Incomplete forms will be rejected. INSTRUCTIONS: 1. This application is for the use of a sole proprietor doing business in the state of Nevada. 2. If you are exempt from the requirements of the State Business License pursuant to NRS 76.020 DO NOT use this form. Please submit a State Business License Exemption form. 3. Return the completed application with the $200.00 business license fee. Refunds are not available on improperly filed applications. 4. File online at www.nvsos.gov or return the completed form to: Secretary of State, 202 North Carson Street, Carson City, Nevada 89701-4201, (775) 684-5708. 5. If paying by check, make your check payable to the Secretary of State. If paying by credit card, you must complete and attach an ePayment Checklist available at www.nvsos.gov in the Forms Library under the Resources section of the Business Center. 6. The sole proprietor applying for the State Business License must sign the application. FORM WILL BE RETURNED IF UNSIGNED. 1* Signature must be that of the sole proprietor. I declare under penalty of perjury that the information provided is true, correct and complete to the best of my knowledge and belief and acknowledge that pursuant to NRS 239.330, it is a category C felony to knowingly offer any false or forged instrument for filing in the Office of the Secretary of State. I understand that this is the name that will be listed as the sole proprietor on the State Business License. First Name Last Name Suffix Last Name Middle (Optional) Suffix X Signature of Sole Proprietor Date Spouse, required only if to be listed on license First Name Middle (Optional) X Signature of Spouse 2 Date You may add up to four businesses associated with this sole proprietor. Entries into this section do not relieve you of other business license or DBA filings required by local/county offices. Business Name(s) 1. 2. 3. 4. 3* Physical Address Physical Street Address 4 6 7 State Zip Code PO Box or Street Address City State Zip Code Mailing Address (if different) 5 City Entity Phone ( ) Email Address Taxpayer Identification # (Dept of Taxation Issued TID) This form must be accompanied by appropriate fees. See instructions. Check here to receive notices electronically (Do Not provide Social Security Number) Nevada Secretary of State BL Application Sole Proprietor Revised: 2-17-11 American LegalNet, Inc. www.FormsWorkFlow.com