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2. INFORMATION
4. If this is a renewal application, has the business ownership changed since the last application?*

   1. New

   1. Renewal
6. Charitable/Religious Name*
7. IRS #*
9. Contact Owner's Name*
11. Main Phone Number*
12. Cell Phone*
14. Email *
16. Secondary Contact Name*
17. Email *
19. Emergency Contact Name*
20. Telephone*
22. IDENTIFICATION
24. Owner's Name*
26. Mailing Address*
28. Phone*
29. Email *
31. Person responsible for upkeep and maintenance of the interior of the property*

    1. Owner

    1. Tenant
33. Person responsible for upkeep and maintenance of the exterior of the property*

    1. Owner

    1. Tenant
35. Person responsible for utilities (water/electric)*

    1. Owner

    1. Tenant
37. Person responsible for snow removal*

    1. Owner

    1. Tenant
39. Person responsible for trash removal*

    1. Owner

    1. Tenant
41. APPLICATION CHECKLIST*

    Please include the following with the submission of the application. All of the items MUST be provided at the time of application. Failure to include proper documentation will result in a delay of your Business License and possible fines.

    1. Trash Collection - (submit contract or invoice)
    2. IRS Determination Letter
    3. Copy of Prince Goerge's county Use and Occupancy (U & O) permit
    4. Copy of current Prince George's County Health Department Inspection certificate for all commercial businesses that prepare food on-site (this is an Annual Inspection)
43. Upload Documents

    Upload required documents.

45. Upload Documents

    Upload required documents.

47. Upload Documents

    Upload required documents.

49. Upload required documents.

    Upload required documents.

51. FEE CALCULATIONS
53. Non-Profit Organization/Faith Based Institution Fee:
    Non-Profit Organization/Faith Based Institution Fee:
54. Price
55. Quantity*
56. Shipping Cost
58. Taxable
60. Reinstatement Fees: $300.00
    After revocation for cause or expiration of license
61. Price
62. Quantity
63. Shipping Cost
65. Taxable
67. Late Fees: Renewal after Deadline - $100.00
    Late Fees: Renewal after Deadline - $100.00
68. Price
69. Quantity
70. Shipping Cost
72. Taxable
74. APPLICANT SIGNATURE

    I hereby certify that the information on this application is true and correct. I hereby certify that I am the business of the subject property and have received permission through a lease or have ownership to conduct business at the property. I am familiar with the applicable codes, requirements, and fines of the City of Mount Rainier. Therefore, I take full responsibility for all code compliance issues as they relate to the upkeep of the building. Further, I agree to conform to all applicable laws and ordinances of  jurisdiction to the City of Mount Rainier.

76. Owner/Representative's Printed Name*
77. Title*
78. Date*
    Date
80. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
82. Electronic Signature*
Leave This Blank:


84. Calculate Totals Proceed to Checkout

* indicates a required field