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 (Clerk’s 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) _____________________________
