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FOR OFFICE USE ONLY: CITF STOCKTON <br /> TAX ACCT. # 10`-l1 F <br /> _ ' ADMINISTRATIVE SERVICES DEPARTMENT <br /> CONTROL# �P REVENUE SERVICES DIVISION-BUSINESS LICENSE TAX <br /> 425 North EI Dorado Street•PO Box 1570•Stockton, CA•95201 <br /> SMC Phone (209)937-8313 Fax(209) 937-7184 <br /> www.stocktongov.com <br /> CLASS DO <br /> sINCBOEBUSINESS LICENSE TAX APPLICATION <br /> ................. ..... .._..... . . . .. ..... <br /> NEW Number of Employees:Full Time Part Time Temporary Enterprise Zone: Yes No <br /> CHANGE Change from Date of Change Bus Lic# <br /> .... ............__ .......... <br /> NOTE: Any change in ownership, address, or business activity, requires a new application. The City of Stockton does not <br /> guarantee that information on this form will be exempt from disclosure under the Public Records Act. <br /> **ALTERED OR INCOMPLETE APPLICATIONS WILL NOT>`BE ACCEPTED**; <br /> BUSINESS INFORMATION: <br /> 1. Business Name (DBA) JQ-lr �Ci���00 Phone ( 702 ) Lf 45'53,'2 <br /> 2. Business Address (No PO Box) 9/6 -7T. Ste/Apt# City '7r061�Z21V StateCat Zip <br /> 3. Business Mailing Address `` G,c�-i�l�.P Ste/Apt# City ` ` State " Zip <br /> 4. Square Footage of Business Facility 1. D 50 s Owner of Property JJe t7?-(6C_ i «RC2 bkz_ <br /> 5. Description of Business Activity 'i"t4"( Q' 2 5 <br /> 6. Are you Chamber of Commerce Green Certified? Yes No ✓ (For information contact Chamber of Commerce(209)547-2770) <br /> 7. Is this a"Green Industry"business? Yes No <br /> 8. Business start date in the City of Stockton Ae w 3vh <br /> 9. Estimated Monthly Gross Receipts in Stockton $ '516 b U D Contractors can elect to use project amount see#10 <br /> 10. Contractor's only: Project Amount CA Contractor's License# <br /> Classification Expiration Date <br /> 11. Seller's Permit# <br /> 12. Federal Tax ID# <br /> 13. Check One: dsingle Owner ❑ Partnership ❑ Corporation ❑ LP ❑ LLC <br /> 14. Owner(s))�(Information: (Attach a separate piece of paper if additional space is needed.) <br /> 1. Name l�2vC-F Address (NO PO Box)_ 16(g M STyr-4-t / 577- <br /> City <br /> TCity State- c6c Zip 9-52-03 Home Phone (Za Lt 14 -3 3�T8 <br /> Soc. Sec.# 7 -- q7 9 8 Date of Birth Z 2-/7 '7 Driver's Lic./I.D.# 7{ tom?5Z-State Cc-�- <br /> 2. Name Address (NO PO Box) <br /> City State Zip Home Phone (_) <br /> Soc. Sec.# Date of Birth Driver's Lic./I.D.# State <br /> COMPLETE PAGE 2 OF THE APPLICATION <br />