CITY OF CRYSTAL CITY Phone: (636) Fax: (636)

Transcription

1 DATE CITY OF CRYSTAL CITY Phone: (636) Fax: (636) CITY BUSINESS LICENSE APPLICATION I, or We, do hereby make application for a business license as: in the City of Crystal City. (Name of Business) Proposed opening date Address of business Do you sell an item subject to retail sales tax? Do you plan to sell/serve alcoholic beverages? Do you plan on having vending machines on the premises? Do you use, store, or generate any of the following? Chemicals Corrosives Ignitable Materials Oxidizing substances Poisonous or infectious substances On premises or in the operation of your business? STATE SALES TAX ID NUMBER A BACKGROUND CHECK IS REQUIRED BY THE MISSOURI STATE HIGHWAY PATROL. INCLUDE WITH YOUR APPLICATION. NO EXEPTIONS. YOUR LICENSE WILL NOT BE PROCESSED WITHOUT THIS INFORMATION A copy of your state license must be provided if retail sales are involved. A statement of no tax due is required from the Department of Revenue. 1

2 APPLICANTS FULL NAME Title (officer, partner, owner) Address Date of Birth Telephone # Social Security # Drivers License # Other Employment References: (please provide names and phone numbers) 1) 2) 3) Description of business to be conducted: Owner of building 2

3 $ RETAIL SALES $ MERCHANTS RETAIL STATEMENT Applicants for merchant s license based on the gross receipts MUST complete a gross receipt statement. I, the undersigned owner/operator of do swear that the ESTIMATED (Proposed business name) gross receipts for a twelve (12) month period shall amount to $ (approximate amount) (Signature) LICENSE PERIOD: JULY 1 ST THROUGH JUNE 30 TH OF EACH YEAR LICENSE FEE: $.50 PER $1, IN GROSS RECEIPTS MINIMUM LICENSE FEE: $25.00 IF NO RETAIL SALES ARE INVOLVED THEN DISREGARD. 3

4 The following questions must be answered by all partners/owners in business. All Questions must be answered YES or NO with initials of each by the answer. l.) Have you had any other business license in the past? If so give the name of the business. 2.) Have you ever been evicted from a building or a business? 3.) Were you in the military? Branch 4.) If in the military did you receive an honorable discharge? 5.) Are you a citizen of the United States? 6.) Have you ever been arrested? If yes, described the charges, location, and date of disposition on the arrest. I understand that the City of Crystal City requires a complete background check; criminal history check and traffic check and make the results known to the Mayor and the City Council for their determination if applicable. I understand that any falsehood or omissions on this application may be cause for the City to refuse or revoke the license I understand that if I am applying for a liquor license that all partners/owners must respond to the Crystal City Police Department for fingerprint-photographs prior to the issuance of a liquor license. I understand that I must submit a no tax due statement from the Mo. Department of Revenue. I hereby attest that all the information contained in this application is true to the best of my knowledge. Date Signature Witness from the City of Crystal City 4

5 EXEMPTION STATEMENT Missouri Worker s Compensation Law To be exempt from worker s compensation insurance requirements, the following must apply: 1.) You are not a contractor and have less than (5) five employees. 2.) You are a contractor and never have anyone working for you, other than yourself. If the terms of these requirements are not met, you must present a certificate of Worker s compensation insurance prior to receiving a license from the City. I, Owner/Operator of hereby certify that the above mentioned business is exempt from the workers compensation requirements for insurance for the following reasons. Please check below which applies to you: The business employs less than (5) five employees I am a contractor and never have anyone working for me other than myself Signature Date 5