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2. As a basis for the City of Oldsmar to issue a Business Tax Receipt in accordance with Ordinance 89-10 and subsequent amendment 2007-08, the undersigned hereby affirms the total number of vending machines at a site in the City of Oldsmar during the preceding twelve months is as follows: (New businesses can use an estimate for the current Receipt period.)
4. Oldsmar address of Vending Machine(s)*
   Use one form for each Oldsmar address
5. Total Number of Vending Machines*
   The Business Tax Receipt fee is $15.00 per machine.
6. Total Amount Due: $
8. Email*
10. Signature*
    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.
11. Date:
    Date:
13. State Licensure

    Vending Machines may require state licensing through the DBPR or FDACS visit

    https://www.myfloridalicense.com/CheckListDetail.asp?SID=&xactCode=3021&clientCode=2015&XACT_DEFN_ID=7576

    or 

    https://www.fdacs.gov/Business-Services/Food/Food-Establishments/Ice-Vending-and-Water-Vending-Machines

15. F.S. 205.0537 Vending and amusement machines
    Amusement and vending machines
Leave This Blank:


20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit

* indicates a required field