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City of Oldsmar Amusement Machine Affidavit

  1. 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.)

  2. Use one form for each Oldsmar address

  3. The Business Tax Receipt fee is $50.00 for the first amusement machine, plus $25.00 for each additional machine.

  4. 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.

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