Business License Application

Transcription

1 VILLAGE OF BURNHAM Manistee Avenue Burnham, Illinois Phone: Fax: Robert E. Polk- Mayor Lus E. Chavez-Clerk License No. Issued: Expiration: Fees: of application: Business License Application APPLICANT: PHONE: BUSINESS NAME: EIN NUMBER: BUSINESS PHONE: BUSINESS ADDRESS: CITY / STATE/ZIP: ADDRESS: ALTERNATE PHONE: TYPE OF BUSINESS: OWNER INFORMATION: Name: Phone: Address: CITY / STATE/ZIP: Sole Owner If applicable: Business DBA Has assumed name been filed with Cook County Clerk? No Yes File: (Submit copy of certified Certificate issued by Cook County Clerk) Type of Business: Retailers Occupation Tax Registration No. Partnership Number of Partners: of Formation Illinois Corporation of Incorporation Limited Liability Corporation of Incorporation Foreign Corporation State of Corporation Business Qualified Page 1 of 6

2 Are there any other businesses you now or previously have owned/operated in Burnham, IL? If yes, list : _Type: Type: Do you own or lease business property? No Yes; Include copy of current lease. Building Own Lease Square Foot Area: Land Own Lease Square Foot Area: Computation of square footage shall be included the entire floor area and any adjacent areas used as an integral part of the necessary operation of business Name of Owner: Address of Owner: Phone: City / State / Zip: Name of Lessor: Address of Lessor: Phone: City / State / Zip: Emergency Contact: Phone: Do you have an alarm system? Alarm Company Number of Vehicles owned and operated by the business: Cars / Trucks Year / Make/Model State & License No. Has applicant had a license in this or another State revoked or suspended? No Yes If Yes, state reason for suspension or revocation, city and state, and the business activity or occupation of applicant. Explain in detail: Are you indebted or obligated in any manner to the Village of Burnham? No Yes Will you have vending machines? No Yes List type and number of machines: Page 2 of 6

3 BUSINESS LICENSE APPLICATION REQUIRED DOCUMENTS Annual Fee $ Inspection Fee(s) $ ** Business Licenses are not transferable ** ** Business Licenses are not renewable-must reapply each year ** ** Notify the Clerk s Office of any Business Changes ** Sole Owner: -Needed Current State ID or Driver s License of Owner Partnership: -Needed General Partnership Agreement Current State ID or Driver s License of partner(s) Illinois Corporation: -Needed Current State ID or Driver s License of member(s) State of Illinois- Articles of Incorporation Operating Agreement Limited Liability Corporation: -Needed Current State ID or Driver s License of member(s) State of Illinois- Articles of Incorporation Operating Agreement Foreign Corporation: -Needed Current State ID or Driver s License of member(s) State s- Articles of Incorporation Operating Agreement Page 3 of 6

4 AFFIDAVIT I, (We), the undersigned Applicant, swear (or affirm) that the statements and information contained in the foregoing Business License Application are true and correct, are made upon my (our) personal knowledge, and are made for the purpose of inducing the Village of Burnham to issue the herein applied for Business License. Required: Sole Owner Print Name s Required: Partnership ** All applications must be notarized ** STATE OF ) COUNTY ) ) SS. I, the undersigned, a Notary Public in and for said County, in the State aforesaid, CERTIFY THAT personally known to me to be the person(s) whose name(s) subscribed to the foregoing instrument, appeared before me this day in person. Subscribed and sworn to before me this day of, 20. (Notary Seal) Notary Public My Commission Expires: Page 4 of 6

5 AFFIDAVIT I, (We), the undersigned Applicant, swear (or affirm) that the statements and information contained in the foregoing Business License Application are true and correct, are made upon my (our) personal knowledge, and are made for the purpose of inducing the Village of Burnham to issue the herein applied for Business License. s Required: Illinois Corporation Name Corporate Seal _ s Required: Limited Liability Corporation Required: Foreign Corporation Print Name Page 5 of 6

6 ** All applications must be notarized ** STATE OF ) COUNTY ) ) SS. I, the undersigned, a Notary Public in and for said County, in the State aforesaid, CERTIFY THAT personally known to me to be the person(s) whose name(s) subscribed to the foregoing instrument, appeared before me this day in person. Subscribed and sworn to before me this day of, 20. (Notary Seal) Notary Public My Commission Expires: Page 6 of 6