TOWN OF TIBURON
1505 Tiburon Blvd., Tiburon, Ca 94920
(415) 435-7373

APPLICATION FOR BUSINESS LICENSE


1. Business Information:

    a. Business Name _______________________________________________________________
    b. Type of Business (describe)____________________________________________________
    c. Business Location (Street) _____________________________________________________
                                        (City) __________________________State __________Zip _________
    d. Business Mailing Address (Street)_______________________________________________
                                        (City) __________________________State _________ Zip__________
    e. Business Phone No. ( )_________________Other Phone No. ( )_____________________
    f.  Sales Tax ID # ______________________________
    g. Date Business Commenced in Tiburon _________________________________________
    h. Business Category (circle one) Retail   Wholesale  Professional  Delivery  Main Street Sales Apartment Owner

2. Owner Information:

    a. Owner(s) Name ______________________________________________________________
    b. Owner(s) Address    (Street)____________________________________________________
                                        (City, State, Zip) ____________________________________________
                                        (Phone Number) ___________________________________________
    c. Owner(s) Drivers License No. & Exp. Date ______________________________________
    d. Ownership Type:
             Sole Proprietorship _______ Social Security No. ______________________________
             Partnership______________ Federal Employers ID No._________________________
             Corporation _____________ Federal Employers ID No._________________________

I hereby certify under penalty of perjury that the information provided in this application is true and I am in compliance with all applicable state and county ordinances governing my business.

Authorized Signature ______________________________ Date _________________________
Print Name ________________________________________ Title___________________________

For questions regarding the application or in determining payment required, contact the Business License Department at (415) 435-7373.

RETURN THIS APPLICATION WITH A CHECK FOR YOUR BUSINESS LICENSE TAX PAYABLE TO "TOWN OF TIBURON" AND MAIL TO 1505 TIBURON BLVD., TIBURON, CA 94920.