OATH
O
F
F
I
C
E
O
F
T
H
E
T
A
X
C
O
L
L
E
C
T
O
R
L
A
T
Y
LAKE COUNTY TAX COLLECTOR
LOCAL BUSINESS TAX RECEIPTS AFFIDAVIT
Business Account Number:
PG 1 of 1LCTC Rev. 12/19
Business Name:
As owner of the above listed business, I state that my business has moved from the original
location to the following address:
*Payment of a transfer fee is 10 percent of the
annual business tax, but not less than $3 nor
more than $25, Lake County Ordinance 2007-1,
Section 13-79(b)
Please check here if your mailing address should
also be changed to the address shown above.
As owner of the business listed above, I state that my business is closed as of
Date
*The Property Appraiser’s office must be notified if you cease doing business in Lake County.
Non-renewal of your Business Tax Receipt does not remove you from the Tangible Personal
Property Tax Roll. www.lakecopropappr.com
*If business is filed under a fictitious name, Limited Liability Company or a Corporation, please visit
www.sunbiz.org to modify the state registration.
I state that I am no longer an owner of the above business and request my name be removed from
the Business Tax Receipt.
Other:
OATH
I have reviewed the information as provided above, and under penalty of perjury,
I declare that the information is true and accurate.
Signature of Owner/Officer/Designee
Printed Name
Date
Title
P.O. Box 327 Tavares, FL 32778-0327 • 352-343-9602 • www.laketax.com
