G:\Zoning 2009\Forms and Sample documents\Website Documents\BTR\Applications\btr_app.pdf Modified:
9.16.2019
City of Pompano Beach
License Year
_____________
Department of Development Services
Business Tax Receipt Division
100 W. Atlantic Blvd Pompano Beach, FL 33060
Application for Business Tax Receipt
Phone: 954.786.4668 / 954.786.4633 Fax: 954.786.4666
Name of Business
___________________________________________________Date____________________
Address of Business__________________________________________________ Zip____________________
Date business opened at this location __________ Number of Employees ______ Square Feet Occupied ______
Mailing Address__________________________City____________________State_________Zip___________
Federal ID # ________________ OR Social Security Number XXX-XX-_____ Sales Tax #________________
Bus. Phone #_______________ Bus. Fax #________________ Web Address ___________________________
Owner’s Name ________________________ Date of Birth_________ Emergency Phone #________________
Owner’s Address _______________________________ City _______________ State _______Zip__________
E-Mail Address____________________________
Corp. Name___________________ Address. _____________________ City ________ State____ Zip_______
Type of Ownership Corporation [ ] LLC [ ] Partnership [ ] Sole Proprietor [ ]
Describe any and all conduct or activity of the business___________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Giving false information on this application is unlawful and may result in prosecution, suspension or revocation of your Business
Tax Receipt.
_______________________________________
(Print)
X____________________________________________
Owner, Partner, or Corporate Officer’s Name Owner, Partner, or Corporate Officer’s Signature
FOR STAFF USE ONLY (DO NOT WRITE BELOW THIS LINE)
Transfer of:
Name
Ownership
Address
New
Inventory Increase
Category change
Transferred Account Number: Transferred License No.
Zoning District:
Paid by: Cash
Check No.
___________
Date Paid: Receipt No.:
The above described
business has been
determined to be
in compliance with use requirements of the district in which the activity is proposed to be located.
not in conformance with the use requirements of the district in which the activity is proposed to be
located.
Category:
Account Number:
Ord. No.:
Zoning Fee:
Zoning Official:
Administrative Fee:
Penalty Fee:
Business Tax Receipt Official:
Business Tax Fee:
Transfer Fee:
Total $:
Date Issued:
Sub Total:
