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<br />"" /111111111111 ~tllllllllllllt <br /> <br />~6:J <br />9 ~ Cb\l <br />/:j <. . <br /> <br />11ft I,e Q--r, U'-- <br />{;f --fk,/s <br />~/f~ <br />~ U5ual/1r (;re-~ +~ DR-1S <br />l( ..' "- ct/Yt(.J>L.-It !te!-fr' R.07/08 <br />~, f!., d' Page 2 <br />bu.-+ + .s ct I ~ fJ! ~~ () L; .fa elf) S Lv::> <br />iJJl 0 ~c SJl..OEJit;;l-TV/'- a.a:~ <br /> <br />ZU~ Se,o-l-~qd--l)d..::: <br /> <br /> <br />1. This application is for a: <br />,BSecondhand Dealer <br /> <br />o Secondary Metals <br />Recycler <br /> <br />2. This application is for a (check one): <br /> <br />o New business ~ Additional location <br /> <br />List current secondhand dealer registration number <br /> <br />~ BJ-[]@][UtI] [RlW ~~ru~ - ~ <br /> <br />: <br />~ <br />... <br />~ <br />ell <br />(3 <br />.... <br />c <br />.t: <br />c.. <br />... <br />o <br />ell <br />Q. <br />t::: <br />ell <br />Ul <br />III <br />ell <br />c:: <br />. <br />. <br /> <br />3. Legal name of corporation, individual owner, limited liability company, partnership, or other. Owner telephone number. <br />::LD c. n A);), r-.JG L L c.. (1;)7 )5'7~-7Q..'5 g X I P- <br />4. Trade or fictitious name (d/b/a) (If different than #3 above): Business telephone number. ..l:::~D <br />--rR<i: AS v~ f- .6 U~ ~e..s ..e OA 0.5 1-1 Ow ( 7~1)51C).-0~ <br />5. Complete physical address of business. Home-based businesses and non-permanent flea markeVcraft show vendors Fax number. <br />must use your home address. Ustlng a post office box, private mailbox, or rural route number is not permitted. <br /> IY) ,'[,ro-f-eJ .:r/J/\ ~$lJl '-J-eJ 7tj39 ::r~/I/3lud. (r;J.7) 5rt 3 - ;;)...33 f..o <br />Street: <br />City/StateJZIP: cof'Qs L.D <br />-z.. e.p h l..f { ~- 11.( ~0 33 '5l-JJ <br />6. Contact name (business owner C<:designe~ Contact telephone number. <br />R116YldA.- 5 f~cU c.YD / c.-Ptt ( 1')-1 ) 51 ()... '1 d.-S 8' :x. JdSj <br />Mailing address [If different than physical address): <br />Street: S Q r,-.....Q.. <br />City/StatelZlP: I E-mail address: <br /> S Q..fY1 12.- rS + Q (Y\ CL S <Q. ; 10-1- cL \ 0.. . c...o /)A.. <br /> <br />9 <br /> <br />7. Is your business registered to collect sales and use tax? g] Yes 0 No <br /> <br />If yes, enter your sales and use tax certificate number: ~ ~ - ~[9 W ~ [j3 [ZJ [11 ~ GJ [1l- W <br /> <br />8. Social Security Numbers are used by the Florida Department of Revenue as unique identifiers for the administration of Florida's <br />taxes. Social Security Numbers obtained for tax administration purposes are confidential under sections 213.053 and 119.071, <br />Florida Statutes, and not subject to disclosure as public records. <br /> <br />a. <br /> <br />Federal Employer Identification Number (FEIN): ~ [7] - D ~ ~ ~ ~ ~ [I <br />~~cial Security Number (SSN) of owner: 000 -00 - 0000 <br /> <br />Of you are required to have an <br />FEIN but have not yet been <br />assigned one, you may cali the <br />Intemal Revenue Service at <br />800-829-4933 to request one.) <br /> <br />b. <br /> <br />FOR OaR USE ONLY <br /> <br />D Approved <br /> <br />D Denied <br /> <br />By: (User 10) <br /> <br />DDDDD <br /> <br />Date <br /> <br />DO/DD/DD <br /> <br />month <br /> <br />day <br /> <br />year <br /> <br />Business Partner No. <br /> <br />DDDDDDD <br />DDDDDDDD <br /> <br />Contract Object (La) <br />