Account #: ______________
Entered by/Date:
______________
DATE: NAME:_________________________________________________________________________ ___________________________________
(If business is in your own name, write your last name first, then your first name second)
FED ID/SSN #: T/A:__________________________________________________________________________ _____________________________
LOCAL TEL #: MA
ILING ADDRESS:____________________________________________________________ _____________________________
FAX #: _______
______________________________________________________ ____________________________________
CONTACT NAME: E-MAIL ADDRESS:________________________________________________________ ________________________________
CONTACT”S CELL: ►FALLS CHURCH STREET ADDRESS OF BUSINESS:______________________________ _________________________
► (Contractors: you must list the Falls Church City job site address above. Annual blanket business licenses are not issued ahead of
imminent work. Licenses issued on a per job site basis only. Worker’s Compensation form and VA Contractors License required)
BUSINESS/WORK START DATE:NATURE OF BUSINESS:____________________________________________________ __________________
(in the City of Falls Church)
NO PAYMENT REQUIRED, But you must apply for, or renew, a1. TOTAL GROSS RECEIPTS OF: $10,000 OR LESS-------------------------
business license stating actual gross receipts, even if it is zero, every year
$30.00 FLAT FEE (non refundable)2. TOTAL GROSS RECEIPTS OF: $10,001 - $50,000--------------------------
IS TAXED AS FOLLOWS (DON’T BREAK OUT THE FIRST $50,000):3. TOTAL GROSS RECEIPTS OF: $50,001 AND ABOVE -------------------
(multiply the entire gross receipts category amount by your specific category rate(s) printed below)
CATEGORY ESTIMATED* PRIOR YEAR ACTUAL CATEGORY/FLAT SUB TOTAL
NUMBER GROSS RECEIPTS GROSS RECEIPTS (x) RATE (=) TAX (+) PENALTY (+) INTEREST (=) DUE
______________________ ______ ________
__________________ __________
____________ ___________ ___________ _____
____________________ _______________________ __________ ________________ ___________ ____ _____ _________________
____________________ ______________________ ___________ ________________ ___________ ____ _____ ________________
*estimated gross receipts amounts are required for those businesses operating in their first partial-year, and their first full 12 month calendar year
TOTAL AMOUNT DUE: SIGNATURE: _________________________________________________ _____________________
AMOUNT PAID:DATE:PRINT NAME: ________________________________________________ _________________ _____________________
Declaration: I declare that all the figures herein given are true, full and correct to the best of my knowledge and belief.
BALANCE DUE: _____________________
BUSINESS LICENSE TAXES & FEES: (Total Gross Receipts includes receipts from all sources subject to this tax)
.0016 times gross receipts amount120301-CONTRACTORS ------------------------------------------------------------
.0019 times gross receipts amount (use FIPS code #51610 only on ST-9 Form)
120302-RETAIL MERCHANTS----------------------------------------------------
.0052 times gross receipts amount120303-PROFESSIONAL-------------------------------------------------------------
.0036 times gross receipts amount120304-SERVICE OCCUPATIONS & COMMISSION MERCHANTS---
.0008 times gross receipts amount120305-WHOLESALE MERCHANTS (who take title)------------------------
.005 of gross receipts - gas, telephone & electric120308-PUBLIC UTILITIES---------------------------------------------------------
.0053 times gross receipts amount120307C-RENTING BY OWNER-COMMERCIAL----------------------------
.0038 times gross receipts amount120307R-RENTING BY OWNER-RESIDENTIAL----------------------------
.0036 times gross receipts amount (minimum $30.00)120309-SPECIALIZED OCCUPATIONS-----------------------------------------
Beer “On Sales” - $75.00 flat fee Beer “Off Sales” - $50.00 flat fee 120306-ALCOHOLIC BEVERAGES----------------------------------------------
Mixed Beverages - seating up to: 100 people - $200.00 flat fee
101 - 150 people - $350.00 flat fee
over 150 people - $500.00 flat fee
Each Banquet - $5.00 flat fee
Caterer - $200.00 flat fee
In addition to the gross receipts tax, there is a flat fee for: 00120399-AMUSEMENT ARCADE OPERATOR----------------------------------
The operation of 1-2 machines: $ 50.00 3-9 machines: $100.00
10 or more machines: $ 200.00
Information & rates available, call (703) 248-5450 Revised 3-7-1900120399-OTHER----------------------------------------------------------------
*If you have a vehicle in the company’s name t
hen it must be registered in Falls Church City, no matter where it’s parked at night
according to the Attorney General’s opinion. Is your vehicle currently registered in the City of Falls Church? Yes:_____ No:_____
OFFICE OF THE COMMISSIONER OF THE REVENUE
Thomas D. Clinton, Commissioner
2020 BUSINESS LICENSE RENEWAL
300 Park Avenue, Suite #202W
Falls Church, VA 22046-3301
Phone: (703) 248-5450 Fax: (703) 248-5212
E-mail: commissioner@fallschurchva.gov City’s web site: www.fallschurchva.gov
/cor
(If your business has moved, you’ll need a new Occupancy Permit for your new space from the Community Planning &
Economic Development Services Department, Phone (703) 248-5080 or e-mail them at: permits@fallschurchva.gov)
click to sign
signature
click to edit
![]()
