Bal Harbour Village Hall 655 96
th
Street, Bal Harbour FL 33154 305-866-4633 Fax 305-868-6575
APPLICATION FOR RESORT TAX REGISTRATION CERTIFICATE
(Per Ordinance No. 411)
Individual Corporate Or Trade Name Under Which Business Will Be Transacted
Name Of Present Owner Or Owners
Street Address Of Business Location
State Whether Corporation, Partnership, Individual Proprietorship Complete Etc.
If A Partnership Or Corporation Complete The Following Schedule :
Full Name of Partners
Or Officers
Home Address
Corporate Officer
Or Interest In Partnership
If A Corporation, Show Name And Address Of Individual Designated To Forward
Resort Tax Reports And Payments:
Name:
Address:
What Kind of Business Do You Operate? -
(Hotel, Motel, Apartment House, Bar, Night Club, Restaurant, Etc. If Combination, E.G. Hotel and Restaurant)
Month
Day
Year
If New Business, Give Opening Date:
If Change Of Ownership, Give Effective Date:
Name, Address, And Telephone Number At Which Books And Records Are Kept:
IMPORTANTAll Information Requested Must Be Given And The Application Signed By The Operator
Signature Of Operator:
Date:
Title:
(State Whether Individual Owner, Member Of Firm, Executor, Administrator,
Trustees, Etc., Or Give Title Of Officer Of Corporation)
M
ail To: Finance Department Bal Harbour Village
655 96
th
Street, Bal Harbour Village, FL 33154
Do Not Write In This Space
Certificate Number
Class
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signature
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