Department of Licenses and Inspections Information: (215) 686-2463
INSTRUCTIONS – PLEASE READ CAREFULLY
1. NAME OF TAXPAYER(S) OR TAX ENTITY – If a corporation, use exact legal corporate name. If a partnership, use
name of partners. If an individual proprietorship, use name of owner (last name first, first name and middle initial). The
entity name is the name which your account will be filed in the name printed on all tax returns mailed to you.
1A. TRADE NAME – If you operate your business under a different name than block 1, enter here.
2. BUSINESS ADDRESS – enter primary business location.
3. MAILING ADDRESS - if different than business address, enter here.
4. BRANCH OFFICE ADDRESSES – Enter only Philadelphia branch offices.
5, 6 - Self-explanatory - Contact Information -
7. FEDERAL EMPLOYER IDENTIFICATION NUMBER – This number is assigned by the Internal Revenue Service to all
corporations and partnerships and to individual proprietors if they employ others. This number must be included on this
8. PENNSYLVANIA STATE SALES TAX NUMBER – Enter Pennsylvania Sales and Use Tax license number or Sales and
Use Tax exemption number.
9, 10 & 11 - INDIVIDUAL’S PARTNER’S OR OFFICER’S NAME; ADDRESSES AND SOCIAL SECURITY NUMBER – This
information is also considered a vital portion of your tax record and must be included on this form in full detail for all
partners, corporate officers and/or individual owners.
12. Temporary Philadelphia Business Tax Number.
13. Check the appropriate organization.
This License will expire at the end of each calendar year along with the
Philadelphia Tax Account Number, and is not renewable.
81-76 (Rev. 9/08)
CITY OF PHILADELPHIA
DEPARTMENT OF LICENSES AND INSPECTIONS
CONCOURSE LEVEL • LICENSE ISSUANCE UNIT
1401 JOHN F. KENNEDY BLVD.
PHILADELPHIA, PA 19102-1687
APPLICATION FOR ANNUAL
Follow Instructions Below:
For further information
PLEASE SEE INSTRUCTIONS BELOW BEFORE ANSWERING ANY QUESTIONS ON THI