Form BQ100 Questionnaire for Occupational License Instructions

COMPLETE ONLY IF YOU HAVE NOT PREVIOUSLY SUBMITTED A QUESTIONNAIRE.

Please make sure that you complete all items. If an item does not apply indicate “NA”. This form MUST be signed and dated.

Line 1:Enter the legal business or trade name. Sole proprietors with no specific business name should enter their name.

Line 2:Enter the address the business uses or will be using while working within Scott County.

Line 3:Enter the mailing address for forms if different from line 2.

Line 4: Enter the businesses email address if applicable.

Line 5: Enter the telephone and fax numbers of the business (including area code).

Line 6: Indicate which legal form of ownership the business uses for federal income tax reporting purposes.

Line 7: List the names of the principal owners, partners or corporate officers.

Line 8: Enter the social security number and/or federal identification assigned to this business for federal income tax purposes.

Line 9: Explain the nature of the business to be conducted within Scott County.

Line 10: Enter the date the business began work within Scott County. This may or may not be the same date the business began operations.

Line 11: Indicate if any business activity will be conducted within the city limits of Georgetown.

Line 12: Indicate whether or not you have employees working in Scott County. If so, enter the number.

Line 13: Indicate whether or not any of the employees indicated on line 12 are residents of Scott County.

Line 14: Indicate whether or not you use subcontractors to perform the work within Scott County. If so, you must provide a list of the names and addresses of those subcontractors. If you are just beginning operations in Scott County and are not sure of the names of the subcontractors you must provide a list as soon as they become available.

Line 15: Enter the accounting period used by the business for federal income tax purposes. In most cases if your taxes are due April 15th then you are filing based upon a calendar year.

Line 16: Enter the person’s name and address that will be responsible for completing your income tax returns. If you complete the returns yourself indicate self-prepared.

Line 17: Enter the name and address of the person you wish to designate as a contact person for matters relating to this occupational license.

MUST be signed by an owner, partner, or corporate officer.