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2. As a basis for the City of Oldsmar to issue a Business Tax Receipt in accordance with Ordinance 89-10 and subsequent amendments, the undersigned hereby affirms the total number of amusement machines (not in arcade) to be taxed by the City of Oldsmar during the preceding twelve months are as follows: (New businesses can use an estimate for the current Receipt period.)
4. Name of Business*
5. Oldsmar address of Amusement Machines(s)*
   Use one form for each Oldsmar address
7. Total Number of Amusement Machines*
   The Business Tax Receipt fee is $50.00 for the first amusement machine, plus $25.00 for each additional machine.
8. Total Amount Due $
9. F.S. 205.0537 Vending and amusement machines
   Vending and amusement machines
11. Email*
13. Signature of Business Owner*
    By typing your name here, you are signing this form electronically. You agree you are submitting this affidavit for processing and is the legal equivalent of your manual signature on this form. You must be the legal business owner or authorized agent which match our registration records. Note: A notarized Letter of Authorization is required for an agent to sign the application or any other correspondence that calls for an agent signature.
14. Date:
    Date:
Leave This Blank:


17. 1. Receive an email copy of this form.
18. Email address

    This field is not part of the form submission.

19. Submit

* indicates a required field