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<br />Title <br /> <br />Date <br /> <br />Title Date <br />FOR OFFICE USE ONLY: <br />Page 2 <br />ACCOUNT # <br />CUSTOMER ID # <br />LICENSE REF # <br />CORPORATION, LLC, or LP INFORMATION: (Must be Registered in California) <br />Name Corp/LLC/LP # <br />Names of Officers/Members <br />President: Secretary: <br />Vice President: Treasurer: <br />Authorized Agent: Contact Phone # <br />Authorized Agent: Contact Phone # <br />The Issuing of your Business License is for revenue purposes only. It does not relieve you from the responsibility of <br />complying with the requirements of any other department of the City of Stockton and/or any other ordinance, law or <br />regulation of the City of Stockton, State of California, or any other governmental agency. <br />Business Licenses are not transferable. It is your responsibility to renew your Business License whether or not you <br />receive a renewal notice. If you are no longer conducting business in the City of Stockton, you must notify us in writing. <br />To appeal a business license that has been denied see SMC 5.04.210.A. <br />I HAVE READ AND UNDERSTAND THE TERMS ABOVE • I HEREBY CERTIFY UNDER PENALTY OF PERJURY THAT THE <br />INFORMATION PROVIDED ON THIS APPLICATION IS TRUE AND CORRECT. <br />0#ner/Aut ed Signature <br />t)U <br />Owner/Authorized Signature <br />Disability Access and Education Fee (SB 1186) <br />**State Mandated Disability Access and Education Revolving Fund. <br />Under federal and state law, compliance with disability access laws is a serious and significant responsibility that applies to all California building owners <br />and tenants with buildings open to the public. You may obtain information about your legal obligations and how to comply with disability access laws at <br />the following agencies: <br />The Division of the State Architect at <br />The Department of Rehabilitation at <br />The California Commission on Disability Access at <br />BELOW IS FOR OFFICE USE ONLY: PLEASE DO NOT WRITE IN ADDITIONAL INFORMATION BELOW THIS LINE <br />Processed By: Date: Business License Taxes/Fees Amount <br />Dept/Div Checked Must Approve or Deny Authorized Signature and Date Registration Tax <br />Planning Approved Denied Mill Tax/Flat Rate Tax . • • <br />Building Approved Denied Penalty • • • <br />Fire Approved Denied Prior Year(s) Taxes • • MI <br />Police Approved Denied <br />• **State Mandated Disability Access <br />and Education Revolving Fund II . 111 <br />MUD/Stormwater Approved Denied Other: Adjustments/Credits III . II <br />Other: Approved Denied Total Due III • 1111 <br />Expiration Date <br />PLEASE RETAIN A COPY FOR YOUR RECORDS