Online BTR Application -Indian Rocks Beach

Business Tax Receipt Application

Name of Person Making Application

First Last

Full Name of Business

Business Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mailing Address for Renewal Notice

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Business Phone #

F.E.I.N. #

or Last 4 digits of S.S.N.#

# of Employees

# of Parking Spaces

Description of Business Activity, Products & Services

*Answer Only Applicable Items Listed Below

USAGE/UNIT/FEE INFORMATION: # Rental Units

MERCHANT: Inventory Amount as of Sept 1 $

RESTAURANT/LOUNGE: Seats-Interior #

Exterior #

Alcoholic Beverage Designation

# of Vending/Game Machines

# of Pool Tables

# of Music Machines

REAL ESTATE: # of Brokers

# of Sales Associates

BEAUTY SALON/BARBER SHOP: # of Stations

MARINA: # of Slips/Storage Units

GAS STATION: # of Pumps

EMERGENCY INFORMATION

(after closing alternate name, address and phone number):

Name

First Last

Phone

Address

Street Address Address Line 2 City State ZIP Code

I, [enter Applicant Name], being duly authorized to sign for the business named above hereby make application for the privilege of engaging in business within the City of Indian Rocks Beach, Florida. I further understand that the business will adhere to the laws, statutes and City ordinances that may apply to this business. I acknowledge that I have read this application, and should the business be found guilty of violation of any law, statute or City ordinance, that the Business Tax Receipt may be revoked by the City of Indian Rocks Beach, Florida, as outlined in Chapter 10 of the City Code of Ordinances.

Applicant Name

First Last

Applicant Signature

Date

Note: The following is required prior to the issuance of a Business Tax Receipt:

Department of Business & Professional Regulation Registration
Department of Business & Professional Regulation Health Certificate (if applicable)
Fire Department Inspection: Call 727/595-1117 to request inspection (if applicable)
Department of Revenue Certificate (if applicable)

PENALTY FOR LATE PAYMENT
Oct 1@10%; Nov 1 @15%; Dec 1 @20%; Jan 1 @25%

NOTE: There shall be a nonrefundable fee of $15.00 for the initial application plus an annual fee based upon the business classification for a local business tax receipt (Ord.15-28)

Payment Information

PRIOR TO SUBMITTING PAYMENT CALL 727-595-2517 FOR FINAL FEE DETERMINATION

Billing(Required)

Street Address Address Line 2 City State ZIP Code

Annual Fee(Required)

Processing Fee

Total

Please note: there is a $3.00 processing fee

Secure Credit Card

Card Holder*

Card Number*

Card Expiration*

Card CVV*

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