ADMISSIONS TAX REGISTRATION FORM

2. City Clerk's Office
   501 N. Anderson St Ellensburg, WA 98926

   501 N. Anderson St Ellensburg, WA 98926

3. CITY OF ELLENSBURG
   Admissions Tax Registration Form

   Admissions Tax Registration Form

4. 

6. Phone: (509) 925-8614

8. Purpose
   For the purpose of levying a tax for admissions to any place charging an admission in the City of Ellensburg pursuant to Ordinance No. 3907.

   For the purpose of levying a tax for admissions to any place charging an admission in the City of Ellensburg pursuant to Ordinance No. 3907.

12. Name of Organization*

13. Business License #*

15. Address*

17. City*

18. State*

19. Zip*

21. Phone Number (day time)*

22. Email address*

24. Business Name and Address if different from above.

26. Responsible Party
    Name and title of the person in charge of the books, records and accounts for the admission charges and tax collections, and the place where they may be examined and audited at all reasonable times.

    Name and title of the person in charge of the books, records and accounts for the admission charges and tax collections, and the place where they may be examined and audited at all reasonable times.

28. Name of contact person*

29. Title*

31. Address*

33. City*

34. State*

35. Zip*

37. Electronic Submittal
    By placing your typed initials in the box, and submitting this form electronically, I CERTIFY that all the information I am providing on this form is true and correct to the best of my knowledge. I also understand that my electronic signature is legally binding as if I were physically signing the form. I understand that any material misrepresentation, omission or falsehood may result in rejection or nullification of my application.

    By placing your typed initials in the box, and submitting this form electronically, I CERTIFY that all the information I am providing on this form is true and correct to the best of my knowledge. I also understand that my electronic signature is legally binding as if I were physically signing the form. I understand that any material misrepresentation, omission or falsehood may result in rejection or nullification of my application.

39. Initial for electronic submittal*

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40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit Submit and Print

* indicates a required field