Accounts Receivable Clearance Application



Accounts Receivable Clearance Application2 Woodward Avenue, Suite 106, Coleman A Young Municipal CenterRevenue Tax Examining Unit (313) 224-2389 / RevenueCollections@ ? SECTION A:? BUSINESS LICENSE ? BUDGET ? CITY COUNCIL ? DDOT ? DPW ? FINANCE ? FIRE ? HEALTH? CIVIL RIGHTS, INCLUSION & OPPORTUNITY (CRIO) ? LAW ? MAYOR ? OMBUDSMAN ? PLANNING& DEVELOPMENT? POLICE ? PURCHASING ? RECREATION ? WATER & SEWAGE OTHER________________________________________ADDRESS OF DEPARTMENT_______________________________________________________________________________________________________DATE SENT_________________________ CONTACT PERSON____________________________________________________________________________PHONE NUMBER_________________________ FAX NUMBER_________________________ EMAIL_____________________________________________CONTRACT AMOUNT $_______________________________? SECTION B: CORPORATIONLICENSE TYPE______________________________________________________CORPORATION NAME_____________________________________________________________________________________________________________ADDRESS_______________________________________________________ CITY/STATE/ZIP_________________________ ____ ? OWN ? LEASECITY PERSONAL PROPERTY NUMBER__________________________________________ FID / EIN NUMBER_____________________________________OTHER CITY-OWNED PROPERTY PARCELS__________________________________________________________________________________________CONTACT PERSON___________________________ PHONE NUMBER_____________________ EMAIL ADDRESS________________________________? SECTION C: PARTNERSHIPLICENSE TYPE_____________________________________________________BUSINESS NAME________________________________________________________________________________________________________________BUSINESS ADDRESS_______________________________________________ CITY/STATE/ZIP____________________________ ? OWN ? LEASECITY PERSONAL PROPERTY NUMBER__________________________________________ FID / EIN NUMBER____________________________________A: PARTNER’S NAME _____________________________________________ PHONE NUMBER________________________________________________HOME ADDRESS__________________________________________CITY/STATE/ZIP_____________________________________ ? OWN ? LEASEDRIVER’S LICENSE #__________________________________ OTHER CITY-OWNED PROPERTY PARCELS ___________________________________________________________________________________________________________________________________________________________________B. PARTNER’S NAME______________________________________________ PHONE NUMBER_______________________________________________HOME ADDRESS__________________________________________ CITY/STATE/ZIP____________________________________ ? OWN ? LEASEDRIVER’S LICENSE #__________________________________ OTHER CITY-OWNED PROPERTY PARCELS ___________________________________________________________________________________________________________________________________________________________________CONTACT PERSON___________________________ PHONE NUMBER____________________ EMAIL ADDRESS_________________________________? SECTION D: SOLE PROPRIETORSHIP LICENSE TYPE____________________________________________________BUSINESS NAME________________________________________________________________________________________________________________BUSINESS ADDRESS_______________________________________________ CITY/STATE/ZIP _________________________ ? OWN ? LEASE CITY PERSONAL PROPERTY NUMBER__________________________________________ FID / EIN NUMBER____________________________________OWNER’S NAME___________________________________ DRIVER’S LICENSE #________________________ PHONE NUMBER_____________________HOME ADDRESS________________________________________ CITY/STATE/ZIP ______________________________________ ? OWN ? LEASE OTHER CITY-OWNED PROPERTY PARCELS_________________________________________________________________________________________EMAIL ADDRESS________________________________________________________________________________________________________________? SECTION E: PERSONAL SERVICESNAME___________________________________________ADDDRESS_______________________________________________ ? OWN ? LEASECITY/STATE/ZIP_________________________________________________________________________________________________________________PHONE NUMBER___________________________ DRIVER LICENSE #___________________________________________________________________OTHER PROPERTY ADDRESSES OWNED IN WITHIN DETROIT_________________________________________________________________________SOCIAL SECURITY NUMBER___________________________________ EMAIL ADDRESS___________________________________________________FOR TREASURY COLLECTION USE ONLY: ? APPROVED? DENIED? DENIED WITH ATTACHMENTS_____________________________________________________________________________________CLEARANCE VALID UNTIL _____________________________SIGNATUREDATE ................
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