BUSINESS TAX RECEIPT APPLICATION (BTR)
Town of Loxahatchee Groves
155 F Road Loxahatchee Groves, Florida 33470 (561) 793-2418 Phone (561) 793-2420 Fax loxahatcheegrovesfl.gov
(To be completed by applicant): **Instructions & checklist on reverse side**
Check Applicable Box:
Commercial
Home Based
New Based
Change of Address
Change Business Name
Transfer of Ownership
Other
_
______________
B
usiness/D
BA/Trad
e Name: _____________________________________________________________________________
(FL Statutes requires registration of a fictitious name or article of incorporation to accompany this application)
Business Location: ____________________________________________________________________________________
Mailing Address: ______________________________City: __________________________State:_____ ZIP:____________
(if different above)
Date Opened: _______________________ Federal Employer ID **OR** Social Security #: __________________________
Business Phone Number: ____________________ Cell/Emergency Number: ____________________________________
E-Mail address: _______________________________________________________________________________________
Nature of Business:_____________________________________**OR**Profession:________________________________
(Roofing Company, Cleaning Service, etc.) (Doctor, Lawyer, etc.)
Description of Services Provided:
__________________________________________________________________________
The Below Signed Applicant For A Town Of Loxahatchee Groves Business Tax Receipt Hereby Acknowledges That This
Business Tax Receipt Is Issued By The Town As Part Of The Town’s Taxing Function And Is Not To Be Construed To Be
Approval In Any Fashion Or Acknowledgement Of Compliance With Applicable Statutes, Laws And Ordinances Including But
Not Limited To Zoning Regulations, Nor Compliance With Any Other Regulators Restrictions Which May Be Applicable To
The Subject Site, Including But Not Limited To The Countrywide Wellfield Protection Ordinance, As Amended From Time To
Time.
Applicant/Qualifier: please print: _______________________________________________________
Address:______________________________________City:_______________________________State:______ZIP:_________
Phone No.______________________ Driver’s License Number: __________________________ Date of Birth: _____________
Applicant/Qualifier Signature:
_______________________________________________________________________________
CLASSIFICATION CODE: ____________________ BTR#________________ STAFF INITIALS_____________________
Zoning Approval: _______________________ Date: ___________________
One Time Zoning Review Fee: $21.00
One Time Registration Fee: $50.00 Business Tax: $___________ Misc. Fees: $__________ Non-Compliant Fee $250.00 Total Fees: $___________
# of coin operated machines Wholesale # sq./ft. Inventory @ cost $
# of restaurants/bar seats
Warehouse/Storage
# sq./ft.
# of employees (required for
manufacturing
Additional information may be required to support these totals such as
seating charts, floor plans and/or lease agreements
click to sign
signature
click to edit
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