Business License Application
Business Status
| What would you like to do today: |
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Business Name and Physical Location
| Business Name or Trade Name |
Crystal Hatori Laa
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| Business Street Address (Physical location of the business cannot be a PO Box) |
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| Business Mailing Address |
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| Business Phone Number |
+18087549270
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| Number of Employees |
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| Please read trough the list carefully and select the closest description of your business: |
HEALTH SERVICES
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| Business Description (Please describe in detail the nature of the business) |
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| Start of business date |
2022-04-05
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| is the business location: |
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| Nature of Ownership |
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Applicant Information (Must be completed by the person filling out this application)
| Name (First and Last) |
Crystal Hatori Laa
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| Home Address (No PO Boxes) |
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| Mailing Address |
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| Phone number |
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| Driver's License Number |
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| Driver's License Expiration Date |
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| Date of Birth |
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| Social Security Number (Last four (4) digits are accepted) |
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Individual/ Sole Proprietor Owner Information (Eligibility Form)
| Name (First and Last) |
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| Title |
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| Home street address (cannot be a PO Box) |
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| Social Security Number (Last four (4) digits are accepted) |
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| Phone Number |
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| *Check the box next to the document you are presenting to the Town, indicating lawful presence |
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| Attach a copy of said document |
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Federal Tax ID or Social Security Number
| Please provide your Federal ID or Social Security Number |
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Transaction Privilege Tax (Sales Tax)
| Transaction Privilege Tax (TPT) Number |
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Application Affidavit
Home Occupation Permit Form
Conditional Home Occupation Permit
| Will you need to apply for a Conditional Home Occupation permit? |
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Prohibited Home Occupations Disclosure
| I hereby declare that in the conduct of my Home Occupation at the above address, I will comply with the requirements pertaining to such occupations as set forth in the Prescott Valley Town Code mentioned above. |
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Preliminary Review
Late Fee
| Do they need a late fee? |
No
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