CITY OF ZEPHYRHILLS
5335 8TH STREET
ZEPHYRHILLS, FLORIDA 33542

PH: 813-780-0020                                                                                                                                                  FAX: 813-780-0021

BUSINESS TAX RECEIPT APPLICATION

I understand that submitting this application does not allow me to operate or engage in any business within the City of Zephyrhills until a Business Tax Receipt is issued. I further understand that anyone who opens a new business without having obtained a  Business Tax Receipt shall be assessed a penalty of 25% of the regular license fee. This shall be in addition to any application delinquent charges. (City of Zephyrhills  Ordinance #978-07, 7/09/07).

PLEASE TYPE OR PRINT CLEARLY:                                                                                               DATE: __________________

1. NAME OF BUSINESS (DBA)____________________________________________________________________________

           (a) CONTACT PERSON_____________________________________________   PHONE _______________________

2. ADDRESS OF BUSINESS ______________________________________________________________________________

3. BUSINESS PHONE _____________________________ CHECK IF APPLICABLE:   INC. _____   or   P.A. _____ 

4. OWNERSHIP INFORMATION:NAME _____________________________________________________________________

      ADDRESS ________________________________________CITY ______________________ST _____   ZIP __________

      F.E.I. NUMBER __________________ or SS# __________________ FL D/L# ____________________________________

5. MAIL RENEWAL NOTICE TO ___________________________________________________________________________

6. EMERGENCY CONTACTS FOR POLICE & FIRE DEPARTMENTS

     (1) Name __________________________________  Home Phone _________________  Cell Phone _________________

     (2) Name __________________________________  Home Phone _________________  Cell Phone _________________

     (3) Name __________________________________  Home Phone _________________  Cell Phone _________________

7. IF STATE REGULATED NEED COPY OF SAID LICENSE ATTACHED TO THIS APPLICATION. ALSO NEED COPY OF                        COUNTY BUSINESS TAX RECEIPT WHERE OFFICE IS LOCATED.

8. CHECK THE FOLLOWING WHICH APPLIES:  ____  NEW BUSINESS       ____  TRANSFER OWNERSHIP

____  TRANSFER ADDRESS & FROM WHERE _______________________________________________________________

9. EXPLAIN NATURE/OPERATION OF BUSINESS _____________________________________________________________

_______________________________________________________________________________________________________

If Insurance Agent, name types of coverage,(e.i. Auto, Life,etc). ____________________________________________________

_______________________________________________________________________________________________________

APPLICANT AFFIDAVIT

I acknowledge that the issuance of a Business Tax Receipt is contingent upon compliance with all ordinances, regulations, and provisions of the City of Zephyrhills. Should any structure or conditions be found in conflict with building codes and fire safety requirements, that department shall set forth its objections and requirements for corrections. It is then my responsibility to correct the deficiency and request a reinspection. The  Business Tax Receipt may not be issued until those corrections are  made in compliance of all City codes and all applicable fees are paid.

I certify that all the information contained herein is true and correct to the best of my knowledge and belief. It is further understood that I must comply with all City of Zephyrhills codes, and failure to correct any conditions in violation is punishable under the code. I understand that if I engage in a business under a Fictitious name, I must comply with the “Fictitious Name Statute,” Section 865.09 Florida Statutes.

Signed:_______________________________________                      Witness:___________________________________
                                      (APPLICANT)