FRANCIS TOWN
2317 South Springhollow Road
P. O. Box 668
Francis, Utah 84036
(435) 783-6236 FAX (435) 783-6186
E-Mail: lhallam@allwest.net
BUSINESS LICENSE APPLICATION
Section I: Business Information
Is this application a: New Application Renewal Change of ownership or location
Name of Applicant ____________________________________________ Date _____________
Is this name registered with the
Business Name _______________________________________ State of Utah Yes No
Type of Business (be specific)_____________________________________________________
Physical Address ______________________________________ Phone No. ( )____________
Mailing Address ______________________________________ Business Start Date ________
Applicant's Address (if different) _______________________________ Phone _____________
Manager's Name (if applicable) __________________________ Phone No. ( ) ____________
Federal License (if any) _________________________________ Expires _________________
Federal ID: SSN or EIN __________________ Utah Corp. LP or LLC # ___________
Sales & Use Tax No. (if not applicable, please sign here) _______________________________
DBA File No. ____________________________
Professional License/State Contractors Number (if applicable) _____________________
Section II: Check all that apply
Approximate number of employees _________
Commercial Home Occupation Sole Proprietorship
General Partnership Limited Partnership Limited Liability Co.
Profit Corporation Non-Profit Corporation Sexually-Oriented
Business or Employee
Section III: Describe Business
______________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Where will your equipment, tools, supplies to conduct you business be stored?_______________ ______________________________________________________________________________
If storage is located at home what will be stored and where?_____________________________ ______________________________________________________________________________
Section IV: Verification of Accuracy - Acknowledgment of Responsibility
Under penalty of perjury, I hereby certify that the information provided for this entire application is complete, accurate and in accordance with Francis Town Ordinances. I further certify that updated information will be provided in writing, as required, to Francis Town within ten (10) days of any change to the business, name, organization or location. I hereby acknowledge that that illegal or fraudulent business practices are grounds for revocation of the business license, as is delinquent payment of the business license fee. This form is an application for a business license. The receipt for payment of license fees thereof does not constitute being approved to operate a business; the actual license will be issued only when approval is given. It is the responsibility of the licensee to be familiar with the ordinance(s) under which the license is applied for. All business licenses are to be renewed yearly. The application and fees provided herein shall be due and payable by the 31st of January of each year, or before commencing a new business, trade, service or profession. All license fees not paid by that shall be considered delinquent and assessed a $25.00 late penalty. Failure to renew by the last day of February of each year shall result in revocation of the business license. Responsibility of renewal is that of the licensee. Failure to receive a renewal notice does not excuse this responsibility.
____________________________________________ _________________________
Signature of Authorized Business Agent/Owner Date
______________________________________________________________________________
For office use only:
Conditional Use Permit Required: Yes No If yes, give date approved by:
Planning Commission ___________ Town Council ______________
Inspection required: Yes No If yes, date inspected _____________
Property zoned appropriately: Yes No
Health Department Inspection required: Yes No If yes, date inspected ____________
Approval of Business License Administrator:
_______________________________________________ Date ___________________
License Fee ___________ Date Paid __________ Rec'd by ________ Receipt #________