Transcription of TAX CLEARANCE APPLICATION FORM - Guam
1 Dip ttamenton Kontribusion yan Adu n EDDIE BAZA CALVO, Governor Maga l hi RAY TENORIO, Lt. Governor Ti ente Gubetnadot DEPARTMENT OF REVENUE AND TAXATION GOVERNMENT OF GUAM Gubetnamenton Gu han JOHN P. CAMACHO, Director Direktot MARIE M. BENITO, Deputy Director Sigundo Direktot Post Office Box 23607, Guam Main Facility, Guam 96921 Tel. / Telifon: (671) 635-1817 Fax / Faks: (671) 633-2643 TAX CLEARANCE APPLICATION FORM Form I-9 NAME: _____ Doing Business As (DBA) Name, if any: _____ SSN:_____ EIN:_____ GRT Account Number: _____ Type of License Applied _____ [ ] NEW [ ] RENEWAL Office Address: _____ Business Mailing Address: _____ _____ Phone Number: _____ _____ (Applicant) _____ (Authorized Signature) (DO NOT TYPE BELOW THIS LINE) _____ The above-stated applicant is hereby issued by tax CLEARANCE for issuance of New/ Renewal Business License.
2 (1) General Licensing ** (2) BPTB/GRT (3) ITAPB (4) COLLECTIONS Branch Stamp Below Branch Stamp Below Branch Stamp Below Branch Stamp Below Cleared By:_____ Cleared By:_____ Cleared By:_____ Cleared By: _____ Date: _____ Date: _____ Date: _____ Date: _____ ** For corporations & LLC only