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B O E - 4 0 0 - M T ( F R O N T ) R E V . 9 ( 1 - 0 3 ) A P P L I C A T I O N F O R S E L L E R S P E R M I T T E M P O R A R Y

STATE OF CALIFORNIA

BOARD OF EQUALIZATION

Limited Partnership (LP) General Partnership

to practice law, accounting or architecture)

BUSINESS CODE

AREA CODE

Limited Liability Company (LLC) Unincorporated Business Trust

APPLICATION PROCESSED BY

VERIFICATION:

2. ENTER FULL NAME OF CORPORATION, LP, LLP, LLC PARTNERSHIP OR UNINCORPORATED BUSINESS TRUST

3. FEDERAL EMPLOYER IDENTIFICATION NUMBER (FEIN)

4. CORPORATE, LP, LLP, OR LLC NUMBER FROM CALIFORNIA SECRETARY OF STATE

5. STATE OF INCORPORATION OR ORGANIZATION

Use additional sheets to include information for more than three individuals.

NUMBER

Other (describe)

DL

Other

FOR BOARD USE ONLY

OFFICE

IND

SECTION I: OWNERSHIP INFORMATION

1. PLEASE CHECK TYPE OF OWNERSHIP

TAX

SR

Sole Owner Corporation

Husband/Wife Co-ownership Limited Liability Partnership (LLP) (Registered

CHECK ONE

Officer

Manager

Member

Trustee

Beneficiary

Partner

Sole Owner or Co-Owner

6. FULL NAME (first, middle, last)

7. SOCIAL SECURITY NUMBER (corporate officers excluded)

8. DRIVER LICENSE NUMBER (attach verification)

9. RESIDENCE ADDRESS (street, city, state, zip code)

10. RESIDENCE TELEPHONE NUMBER

CHECK ONE

Officer

Manager

Member

Trustee

Beneficiary

Partner

() Sole Owner or Co-Owner

11. FULL NAME (first, middle, last)

12. SOCIAL SECURITY NUMBER (corporate officers excluded)

13. DRIVER LICENSE NUMBER (attach verification)

14. RESIDENCE ADDRESS (street, city, state, zip code)

15. RESIDENCE TELEPHONE NUMBER

CHECK ONE

Officer

Manager

Member

Trustee

Beneficiary

Partner

( Sole Owner

)

16. FULL NAME (first, middle, last)

17. SOCIAL SECURITY NUMBER (corporate officers excluded)

18. DRIVER LICENSE NUMBER (attach verification)

19. RESIDENCE ADDRESS (street, city, state, zip code)

20. RESIDENCE TELEPHONE NUMBER

(

)

SECTION II: BUSINESS INFORMATION

21. BUSINESS NAME [DBA] (complete if different from entity name)

22. DID YOU INCLUDE A COPY OF YOUR PARTNERSHIP AGREEMENT?

Yes

No

23. BUSINESS ADDRESS (street, city, state, zip code) [do not list P.O. Box or mailing service]

24. BUSINESS TELEPHONE NUMBER

(

)

25. NAME OF CONTACT PERSON (person responsible for filing tax return)

26. MAILING ADDRESS OF CONTACT PERSON (street, city, state, zip code)

27. CONTACT TELEPHONE NUMBER

(

)

28. NAME & LOCATION OF BANK OR OTHER FINANCIAL INSTITUTION (Note whether business or personal)

CHECKING ACCOUNT NUMBER(S)

SAVINGS ACCOUNT NUMBER(S)

continued on reverse

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