APPLICANT NAME AND MAILING ADDRESS:
City of Richmond, Virginia
Division of Collections
900 East Broad Street, Room 102
P.O. Box 26624
Richmond, VA 23261
THE INFORMATION PROVIDED IS TRUE AND COMPLETE. I UNDERSTAND MY OBLIGATION FOR THIS LICENSE. BUSINESS LICENSE RECEIPTS ARE
SUBJECT TO AUDIT.
APPLICATION FOR CITY OF
RICHMOND BUSINESS LICENSE
LICENSE YEAR 2015
Account #
IMPORTANT: Renewal application must be filed
and taxes and/or fees paid in full by 3/1/2015.
Your 2014 license expired 12/31/2014.
This license must be surrendered upon demand.
BUSINESS TYPE DESCRIPTION
TAX
RATE
TAX DUE / (REFUND)
2014 ACTUAL
GROSS RECEIPTS
2014 TAX DUE 2014 TAX PAID
.00 X =
A B
2014 – LICENSE TAX ADJUSTMENT – 2014
CALCULATE ADJUSTMENTS ONLY IF YOUR BUSINESS BEGAN AFTER JANUARY 15, 2013
INSTRUCTIONS:
Type or print only.
Provide complete information.
Sign in the space provided at the bottom of the application.
Return with check payable to City of Richmond”.
A 2015 business license will be returned to you.
For assistance call (804) 646-7000.
For information or forms, visit our website at www.richmondgov.com.
IMPORTANT — PLEASE READ:
Up to 10% penalty will be added (subject to a minimum penalty) if payment
is not postmarked or received by the Department of Finance on or before
March 1, 2015.
Your business must be properly zoned before you may begin operating
(Zoning phone no. (804) 646-6340).
All trade / assumed names must be registered with the Clerk of the Circuit
Court before the license can be issued (Clerks phone no.
(804)646-6530).
If gross receipts for 2014 were less than $100,000, please see reverse.
You will receive a separate renewal form for each line of business or
charge on your account (i.e. Restaurant, Beer & Wine and Mixed
Beverage will produce 3 renewal forms).
TELEPHONE: FAX:
EMAIL ADDRESS:
EMPLOYER NO. OR S.S. NO.:
RICHMOND CITY BUSINESS ADDRESS:
COMPANY:
TRADE NAME:
PRESIDENT:
REGISTERED AGENT:
NO./STREET:
CITY/STATE/ZIP:
TELEPHONE:
A B
DATE CEASED BUSINESS IN RICHMOND: MM DD YY CHECK ONE: q INDIVIDUAL q PART. q CORP. q LLC
LICENSE PREPARER OTHER THAN LICENSEE: FAX #: ( ) -
DATE BEGAN BUSINESS IN RICHMOND: MM DD YY CERT OF OCCUPANCY NUMBER:
SSN OR FED ID#: VA SALES TAX #: TELEPHONE #: ( ) -
Account Number:
2015 – CITY OF RICHMOND – 2015
BUSINESS, PROFESSIONAL, & OCCUPATIONAL LICENSE
Account Number:
CAT TYPE ABC# BUSINESS TYPE DESCRIPTION 2014 GROSS RECEIPTS TAX RATE AMOUNT DUE
.00 X =
LICENSEE:
AMOUNT
PENALTY
T/A:
INTEREST
TOTAL
AMOUNT PAID
Ü
Printed Signature
Date _________ Phone __________________ Name _____________________________ (Required) _____________________________
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