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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 that the total machine(s) to be taxed by the City during the preceding twelve months are as follows: (New businesses can use an estimate for the current license period.)
4. Name of Business*
5. Business Address*
7. Email Address:*
9. Total Number of Machines*
   The Business Tax Receipt fee is $37.00 for one through 10 machines plus $3.00 for each additional machine thereafter.
10. Total Amount Due
11. Date:
    Date:
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.
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16. 1. Receive an email copy of this form.
17. Email address

    This field is not part of the form submission.

18. Submit Submit and Print

* indicates a required field