Date _________________
Check # _______________
Dear Business Owner(s): Amount Paid ___________
Please complete the enclosed application for your 2010 City of Osceola Business License, which is due by January 1, 2010. The term of the license issued shall begin January 1, 2010 and ends December 31, 2010. The cost of the license is $25.00. A reminder that Ordinance 90-04 does not allow a business license to be issued if the business is in arrears to the City, including taxes, utilities, sales tax, etc.,
Missouri
State Sales Tax Number AND a Federal Identification Number is
required.
Please complete the following application and return it in
person or by mail to: City of Osceola,
Attention: Glenna Pritchard, City
Collector – Business License, P.O. Box 561, Osceola, MO 64776.
Please check (√) one of the following: New: _____ Renewal: _____
Today’s Date: ________________ Name of Business: ______________________________________________
Please indicate ownership status by checking (√) one of the following:
Individual: _____ Partnership: _____ Corporation: _____
Bus. Street Address: ___________________________ Bus. Mailing Address: ___________________________
City: _____________________________________ State: ______________________ Zip: _________________
Type of Business: ______________________________ BusinessPhone #: (_______)___________________
Owner(s) Name: ________________________________ Emergency Phone#: (_______)____________________
Owner(s) Home Phone #: (_____)_________________ Owner’s Address: ______________________________
Name of the Manager: ___________________________ Manager’s Home Phone #: (______)_______________
Name of person to contact at night: ________________________ Phone #: (_______)_____________________
Owner of the Building: Name: ___________________________ Phone #: (_______)_____________________
Any flammable or explosive items stored or used in your business? Please check (√) one: Yes _____ No _____
If yes, what and where stored? __________________________________________________________________
Sales Tax Number*: ________________________ *If required per Section 144.083.2 RSMo
Worker’s Comp. Coverage through**: __________________________**If required per Chapter 287, RSMo
Federal Identification #: _____________________
Liability Insurance Policy #: ____________________________ (Attach Copy of)
(Certificate of Insurance)
Effective
August 28, 1998, only construction contractors will be required to show proof
of coverage when purchasing a City Business License. If your business is exempt, complete the following “Sworn
Statement of Exemption”.
The Missouri Worker’s compensation Law, Chapter 287,
RSMo, does not require Worker’s Compensation coverage for the business listed
below:
Business Name: _______________________________________________________________
Name of Owner(s): ____________________________________________________________
Signature of Owner(s): _________________________________________________________
I/We understand this Business License authorized only the vending of goods, wares, merchandise and/or services for the activity described in the Detailed Description of Business Activity for this application.
I understand that a Business License may NOT be issued the same day, if all the information is NOT completely filled out on this form.
_____________________________________________ ________________________________
Signature of Owner/Manager Date
_____________________________________________
Printed Name of Owner/Manager