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2. The City of Oldsmar issues annual Business Tax Receipts based on the number of employees you will employ at the business to be taxed by the City for the fiscal year (Oct. 1 – Sept. 30). Pursuant to Ordinance 89-10, as amended, the undersigned affirms the following:
   Manufacturers need additional receipts for other activities (i.e., retail sales, repairs, equipment rental and the like).
4. Total Number of Employees *
   Persons employed: Greatest number within the given tax year.
5. Amount Due
6. Name of Business*
8. Business Address:*
9. Email Address:*
11. Computation of taxes per person employed is as follows:

    1. One employee $50.00
    2. Two to five employees $87.00
    3. Six to 15 employees $112.00

    1. 16 to 25 employees $137.00
    2. 26 to 50 employees $187.00

    1. 51 to 100 employees $250.00
    2. Over 100 employees $312.00
13. I certify that the information provided is true and accurate.
15. 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.
16. Date:
    Date:
Leave This Blank:


19. 1. Receive an email copy of this form.
20. Email address

    This field is not part of the form submission.

21. Submit

* indicates a required field