1. Business Name ____________________________________________________________________
2. Business Location (street) _______________________________________________________
                     (city) ______________________________(state) __ (ZIP) __________
3. Business Mailing Address (street) ________________________________________________
                            (city) ________________________(state) __(ZIP) __________ 
4. Business Phone No. ______________________ Other Phone No. ________________________
5. Type of Business _________________________________________________________________
   Sales Tax I.D. Number: ___________________________________________________________
6. Contact Person ___________________________ 7. Date Business Open _________________
8. State Contractors License No. ____________________________________________________
9. Owner(s) Name ____________________________________________________________________
10. Owners(s) Address (street) ______________________________________________________
                      (city) ________________________________(state)__(ZIP)__________ 
    Owners(s) Phone Number __________________________________________________________
11. Ownership Type:
    Sole Proprietorship ____ 	Social Security No. _________________________________		
    Partnership        ____	Federal Employers ID No. ____________________________
    Corporation        ____	Federal Employers ID No. ____________________________
12. Refer to BUSINESS LICENSE TAX SCHEDULE to determine payment required. Separate
    application is required for persons engaged  in more than one business.  Complete 
    the following which applies to your business:
    a. General Business - Class A, B, C, or D			Class #________________
       Gross Receipts for your preceding business year 		      $________________
       Tax - Refer to TAX SCHEDULE			       	      $________________
    b. Delivery Business - Without Fixed Place of Business in Marin County
       Number and Capacity of Vehicles _________________________________________________
       Tax - Refer to TAX SCHEDULE                                    $________________
    c. Living Accommodations - Hotel, Motel, Apartment, House for Rent
       Number of Units                                                 _______________
       Tax - Refer to TAX SCHEDULE                                    $______________
    d. Other Licenses - Solicitors Taxicab, Auctioneers, Xmas Tree Lots
       Describe Business Activity ________________________________________________________________
       Tax - Refer to TAX SCHEDULE	                              $_______________
                                                         TOTAL PAID   $_____________________ 
13. Any food or drink  dispensing establishment or restaurant must submit with this 
    application a copy of their Health Permit from the Marin county Public Health
    Department.
14. Is this business a nuclear weapons contractor? ____Yes ____No

15. 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_______________

RETURN THIS APPLICATION WITH A CHECK FOR YOUR BUSINESS LICENSE TAX PAYABLE 
TO THE MARIN COUNTY TAX COLLECTOR.  UPON RECEIPT A LICENSE WILL BE ISSUED AND SENT 
TO THE BUSINESS MAILING ADDRESS.  SEND TO:
MICHAEL J. SMITH
COUNTY OF MARIN TAX COLLECTOR
P.O. BOX 4220
SAN RAFAEL, CA 94913-4220
For questions regarding the application or in determining payment required, contact Tax Collector's
Business License Section at (415)499-7045.