Alabama Certificate Of Compliance Form – Fill Out and Use This PDF

FOR INFORMATIONAL PURPOSES ONLY

AlAbAmA DepArtment of revenue

Application for Certificate of Compliance	FORM
	10/2015
	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)

BUSINESS ADDRESS

STATE OF INCORPORATION	FOR BUSINESSES INCORPORATED IN ALABAMA, ENTER COUNTY OF INCORPORATION			DATE OF INCORPORATION
SECRETARY OF STATE ENTITY ID		DAYTIME TELEPHONE NUMBER	EMAIL ADDRESS
____ ____ ____ — ____ ____ ____		(      )

2REQUESTOR (Please Type or Print)

NAME

ADDRESS (THE CERTIFICATE OF COMPLIANCE WILL BE MAILED TO THIS ADDRESS.)

DAYTIME TELEPHONE NUMBER	FAX NUMBER	EMAIL ADDRESS
(      )	(      )

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