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Local Business Tax Receipt Application Form

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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.

If yes, you must obtain a certificate of use from Broward County Zoning. See BMSD Zoning website for more information: http://www.broward.org/Planning/Zoning/Pages/Default.aspx

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 *

Phone *

8. Social Security # / EIN *

9. Type of Business *

10. Date business Opened in Broward County *

11. Number of employees (including owner and principals) *

Email *

Machine's type (Merchandise or Amusement) *

Name of Applicant *

Title *

(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) *

(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 SIGNING THIS FORM, IF ANY OF THE ABOVE IS NOT TRUE, I WILL BE GUILTY OF A MISDEMEANOR OF THE SECOND DEGREE.

Creat de AIPSS

Broward

Local Business Tax Receipt Application Form​​​

Details

SUBJECT: FICTITIOUS NAME ACT: “FS 865.09”

Local Business Tax Receipt Application Form