FOR INFORMATIONAL PURPOSES ONLY
AlAbAmA DepArtment of revenue
Application for Certificate of Compliance |
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10/2015 |
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COM: ACC |
NOTE: If you have questions concerning the completion of this form, please call (334) 242-1189.
1 BUSINESS INFORMATION (Please Type or Print)
EMPLOYER IDENTIFICATION NUMBER
BUSINESS ADDRESS
STATE OF INCORPORATION |
FOR BUSINESSES INCORPORATED IN ALABAMA, ENTER COUNTY OF INCORPORATION |
DATE OF INCORPORATION |
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SECRETARY OF STATE ENTITY ID |
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DAYTIME TELEPHONE NUMBER |
EMAIL ADDRESS |
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2REQUESTOR (Please Type or Print)
NAME
ADDRESS (THE CERTIFICATE OF COMPLIANCE WILL BE MAILED TO THIS ADDRESS.)
DAYTIME TELEPHONE NUMBER |
FAX NUMBER |
EMAIL ADDRESS |
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3 TO BE COMPLETED BY NON-PROFIT COMPANIES ONLY:
aIf entity is not required to file a Business Privilege Tax Return, check this box. .......
bIf entity not required to file an Income Tax Return and files a
Form 990 (does not include 990T) for Federal purposes, check this box. ............
4 FOR SINGLE MEMBER LIMITED LIABILITY COMPANIES THAT ARE DISREGARDED
OWNER NAME
OWNER EMPLOYER IDENTIFICATION NUMBER
NOTE: This field can be a Federal Employer Identification Number (FEIN) or Social Security Number (SSN).
Alabama Department of Revenue
Certificate of Compliance
4227 Gordon Persons Building
50 North Ripley Street
Montgomery, AL 36132
Fax: (334) 242-1030