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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 following represents the true number of employees who will be employed during the fiscal year (Oct. 1 – Sept. 30) by the firm making application for this Business Tax Receipt.
   New businesses can use an estimate for the number of employees for the remainder of the current fiscal year.
4. Name of Business*
5. Business Address*
7. Email Address:*
9. Number of Employees*
10. Select one

    1. 1 Employee $50.00
    2. 2 to 4 Employees $62.00
    3. 5 to 10 Employees $75.00
    4. Over 10 Employees $87.00
11. Total Amount Due
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