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BOE-400-MT (BACK) REV. 9 (1-03)

SECTION III: SELLING LOCATION AND EVENT INFORMATION

29. PERIOD OF SALES

30. ADMISSION CHARGED

FROM: 31. WHAT WILL YOU SELL?

THROUGH: 32. PROJECTED SALES (if unknown, enter estimated amount)

Yes

No

33. COST OF SPACE RENTAL (if any)

34. ORGANIZER OF EVENT (if any)

ADDRESS (street, city, state, zip code)

35. TELEPHONE NUMBER

(

)

36. SELLING LOCATION (physical location or address)

37. HOW MANY SELLING LOCATIONS WILL YOU HAVE? (if more than one, list all locations)

CERTIFICATION All owners and partners must sign below.

I am duly authorized to sign the application and certify that the statements made are correct to the best of my knowledge and belief. I also represent and acknowledge that the applicant will be engaged in or conduct businesses as a seller of tangible personal property.

NAME (typed or printed)

SIGNATURE

DATE

NAME (typed or printed)

NAME (typed or printed)

NAME (typed or printed)

SIGNATURE

SIGNATURE

SIGNATURE

DATE

DATE

DATE

If you have not been instructed where to return your application, you may return it to a Board field office. Call 1-800-400-7115 for locations and telephone numbers.

FOR BOARD USE ONLY Furnished to Taxpayer

REPORTING BASIS

FORMS

PUBLICATIONS

MONTHLY

SECURITY REVIEW

BOE-598 $ BOE-1009

TAX RETURN TAX RATE CHARTS BOE-530-B

BY

APPROVED BY

REGULATIONS

REMOTE INPUT DATE

BY

REG 1668 REG 1698 REG 1700

Permit Issued

Date

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