HomeMy WebLinkAboutVoluntary Disclosure Application
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City of Renton Tax & Licensing • 1055 S Grady Way, Renton, WA 98057 • 425-430-6851 • taxandlicensing@rentonwa.gov • rentonwa.gov
City of Renton Tax & Licensing Voluntary Disclosure Program Application
This a voluntary program application. Businesses can use this form to apply for the City of Renton’s Voluntary
Disclosure Program; a letter may be submitted in place of this application. Applications should also include:
Schedules (by year) showing gross income generated in Renton by classification, along with any deductions.
Confidential Tax Information Authorization form if the business is represented by a third party.
Business Legal
Name:
Trade Name
(dba):
Physical
Address:
Mailing
Address:
Contact Name: Title:
Phone: Email:
Are you being represented by a third party?
If yes, include your completed Confidential Tax Information Authorization form ☐ Yes ☐ No
Have you previously been contacted by the department? ☐ Yes ☐ No
Have you engaged in evasion or misrepresentation? ☐ Yes ☐ No
Is the business currently under audit by the City of Renton? ☐ Yes ☐ No
Description of business activities:
How did you establish nexus with the City of Renton?
Date of engaging in business in the city:
Additional notes:
CERTIFICATION
I hereby certify that the statements and information provided on this application are true and complete to the best of my knowledge.
Signature:
Date:
Name:
Title: