BUSINESS TAX RECEIPT APPLICATION

TYPE: NEW BUSINESS HOME-BASED BUSINESS POSTAL BOX ADDRESS CHANGE NAME CHANGE TRANSFER CLASSIFICATION CHANGE

DATE BUSINESS STARTED IN SUNRISE: ____________________________

DATE OF APPLICATION: __________________________________________

CORPORATION NAME: ______________________________________________________________________________________________________________

CITY/STATE/ZIP CODE ____________________________________________

BUSINESS PHONE NUMBER _______________________________________

TAX ID NUMBER _________________________________________________

MAILING ADDRESS _______________________________________________

CITY/STATE/ZIP CODE ____________________________________________

OWNER/APPLICANT NAME ________________________________________

DRIVERS LIC. NO. _______________________BIRTHDATE______________

OWNER/APPLICANT HOME ADDRESS _______________________________

CITY/STATE/ZIP CODE____________________________________________

HOME PHONE NUMBER ___________________________________________

EMAIL ADDRESS ________________________________________________

FULLY DESCRIBE EXACT NATURE OF BUSINESS (INCLUDING A COMPLETE LIST OF SERVICES PROVIDED):

EATING ESTABLISHMENTS ONLY:

WILL THERE BE LIVE OR MECHANICAL MUSIC? Yes No

IF YES, WHAT TYPE? ________________________

ALCOHOLIC BEVERAGES? Yes No TAKE OUT SERVICE? Yes No DELIVERY SERVICE? Yes No RETAIL SALES? Yes No
GASOLINE SERVICE STATIONS ONLY:
NUMBER OF NOZZELS: __________ IS THERE A REPAIR SHOP? Yes No IF YES, HAS PLANNING APPROVAL BEEN GRANTED? Yes No
CAR WASH? Yes No CONVENIENCE STORE? Yes No ALCHOLIC BEVERAGE SALES? Yes No TOBACCO SALES? Yes No
ALL BUSINESSES:
RETAIL SALES? Yes No IF YES, PROVIDE YEARLY INVENTORY OF GOODS AT YOUR COST: $______________ (MUST COMPLETE AFFIDAVIT)
WHOLESALE? Yes No IF YES, PROVIDE YEARLY INVENTORY OF GOODS AT YOUR COST: $______________ (MUST COMPLETE AFFIDAVIT)
VIDEO GAMES? Yes No IF YES, HOW MANY? _______
VENDING MACHINES? Yes No IF YES, HOW MANY? _______

BILLIARD TABLES? Yes No IF YES, HOW MANY? _______

DAILY HOURS OF OPERATION: _____________________________________ NUMBER OF EMPLOYEES: ______ FULL-TIME

______ PART-TIME

I swear or affirm the information given on and with this application is true to the best of my knowledge and belief. I am authorized to act and bind the firm in all
manners connected with the business.
Applicant Signature: ______________________________________________

Printed Name: _________________________Title_______________________

OFFICIAL USE ONLY:

FIRE FEE CODE _______________________ CONTROL # _______________________ LICENSE # _______________________