HTML Preview Application For Local Business Tax Receipt page number 1.
THIS APPLICATION MUST BE PRESENTED IN PERSON TO THE OFFICE LISTED BELOW FOR PROCESSING
Board of County Commissioners, Broward County, Florida
Finance and Administrative Services Department
REVENUE COLLECTION DIVISION ~ Tax & License Section
115 S. Andrews Avenue Room A-100, Fort Lauderdale, Florida 33301 (954) 831-4000
APPLICATION FOR LOCAL BUSINESS TAX RECEIPT (Formally Known as Occupational License)
A BUSINESS TAX RECEIPT IS NOT A GUARANTEE THAT YOUR BUSINESS IS OPERATING IN COMPLIANCE WITH LOCAL LAWS.
IF YOUR BUSINESS IS LOCATED WITHIN A MUNICIPALITY’S JURISDICTION, CHECK WITH THAT MUNICIPALITY FOR THE
ZONING REQUIREMENTS.
LINK TO CITIES IN BROWARD: http://www.rootsweb.com/~flbrowar/cities.html
1. Is your business within the unincorporated area of Broward County? Yes_______ No________
If yes, you must obtain a certificate of use from Broward County’s Building Code Services your Business Tax
Receipt will be issued. Their office is located at 1 N. University Dr., Plantation FL 33324
http://www.broward.org/building/welcome.htm
2. Name of Business _____________________________________________________________________________
3. Name of owner, principal or officer_________________________________________________________________
4. Business Location_______________________________________________________________________________
Street City Zip Code
5. Owner Address: ________________________________________________________________________________
Street City Zip Code
6. Mailing Address: ________________________________________________________________________________
Street City Zip Code
7. Business Phone ____________________________ 8. Social Security # or Federal ID # ___________________________
9. Type of Business ___________________________ 10. Date business Opened or will open ______________________
11. Number of employees (including owner and principals) _________
12. Do you own (not lease) any coin-operated, merchandise, service or amusement machines on the premises?
Yes______No______How many? _________
What type of machine(s)? (Merchandise or Amusement) _______________________________
Date ____________Name of Applicant (Please Print) ________________________________________________
Signature _______________________________________________Title:__________________________________
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SUBJECT: FICTITIOUS NAME ACT: “FS 865.09”
(1) I declare that I have registered, or will register, with the Division of Corporations of the Department of State, for the
Fictitious Name Act.
PRINT YOUR NAME________________________________________________________________________________
PRINT YOUR FICTITIOUS NAME (D/B/A) ______________________________________________________________
OR
(2) I do not have to comply with the Fictitious Name Act because: Check Appropriate Box
I AM USING MY FULL LEGAL NAME
MY BUSINESS IS REGISTERED AS A CORPORATION
OTHER
FAILURE TO COMPLY WITH THE FICTITIOUS NAME REGISTRATION PROVISIONS OF SECTION 865.09, FLORIDA STATUTES, IS
A MISDEMEANOR OF THE SECOND DEGREE AND PUNISHABLE AS PROVIDED IN SECTION 775.082 OR SECTION 775.083,
FLORIDA STATUTES.I UNDERSTAND THAT BY SIGNING THIS FORM, THAT IF ANY OF THE ABOVE IS NOT TRUE, I WILL BE
GUILTY OF A MISDEMEANOR OF THE SECOND DEGREE.
Signature __________________________________________________________ Date ___________________________________________
THIS AFFIDAVIT IS NOT THE APPLICATION FOR THE REGISTRATION OF YOUR FICTITIOUS NAME.
Fictitious Name Registration Packets can be obtained in the Governmental Center’s Main Lobby at the Security Desk or:
Florida Department of State, Division of Corporations (850)-488-9000
You may register on-line at:
www.sunbiz.org
FOR OFFICE USE ONLY
Form No. 401-279A (Rev 03/09)
Account ____________________________