Form Center

2. As a basis for the City of Oldsmar to issue a Business Tax Receipt in accordance with Ordinance 89-10 and subsequent amendments, the undersigned hereby affirms that the total amount of motel units is reported as follows:
4. Name of the Business*
5. Business Address*
7. Email*
9. Total Number of Units*
   The Business Tax Receipt fee is $50.00 for the first ten motel units plus $3.00 for each additional motel unit thereafter.
10. Total Amount Due
12. Signature of Business Owner*
    By typing your name here, you are signing this form electronically. You agree you are submitting this affidavit for processing and is the legal equivalent of your manual signature on this form. You must be the legal business owner or authorized agent which match our registration records. Note: A notarized Letter of Authorization is required for an agent to sign the application or any other correspondence that calls for an agent signature.
13. Date:
    Date:
Leave This Blank:


16. 1. Receive an email copy of this form.
17. Email address

    This field is not part of the form submission.

18. Submit

* indicates a required field