Form Fl 33831 - County Local Business Tax Account Application - 2013
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4OFFICIAL USE ONLY
OFFICE OF JOE G. TEDDER, TAX COLLECTOR FOR POLK COUNTY, FLORIDA
Account Number Issued
E
D
T
& E
D
CONOMIC
EVELOPMENT
AXES
NFORCEMENT
EPARTMENT
PO Box 2016 | Bartow, FL 33831-2016 | Tel. 863-534-4700 | Fax: 863-534-4741 | Email:
COUNTY LOCAL BUSINESS TAX ACCOUNT APPLICATION FORM
PAGE 1
SECTION
Application Instructions: Please print. Enter all required information. Once completed, follow payment instructions at the bottom of page 2.
Note: Tangible Personal Property information and the telephone number and email address provided in this application are recorded on behalf of the Property Appraiser as part of the applicant’s
tangible personal property tax return (required under F.S. 193) and are not subject to a regular public records request. Applicants can have their telephone number and email address made
available to the public by checking the applicable box provided. Social Security (SSN) or Federal Employment Identification (FEIN) Number is required under F.S. 205.0535 (5). SSN and FEIN
are not subject to regular public record requests.
1.
Name of Applicant (Owner or Principal):
Enter the legal name of the owner or principal of the business making application.
First
M.
Last
Sur.
2.
Business Entity Type & Name:
Check one Business Entity Type and enter the Legal Name of the Business where applicable.
Corporation
Enter Corporation’s Legal Name
General Partnership
Enter General Partnership’s Legal Name
Limited Partnership
Enter Limited Partnership’s Legal Name
Limited Liability Company
Enter Limited Liability Company’s Legal Name
Sole Proprietor (Individual)
No Entry For Sole Proprietor
Legal Name Of Sole Proprietor Should Be Printed In Section1
3.
Fictitious Name:
A Fictitious Name or “Doing Business As” Name is used by a Corporation, General Partnership, Limited Partnership,
Limited Liability Company or Sole Proprietor that is different from their legal name. If applicable, enter the Fictitious Name and Number provided by
the Florida Department of State, Division of Corporations.
(Note: Fictitious Name Numbers are obtained online at )
Enter Fictitious Name:
Enter Fictitious Name Number:
Note: If Fictitious Name is provided above without a Fictitious Name Number, the applicant is required to explain why they do not need to comply with the Fictitious Name Registration Act:
4.
Business Location:
Enter physical location of business.
Address
City
State
Zip
5.
Location Boundary:
Indicate the boundary status of the physical location of the business.
Check only one
A.
Outside of Polk County.
B.
In Polk County and inside the city limits entered in Section 4.
C.
In Polk County only (not inside city limits).
6.
Mailing Address:
Enter mailing address if different from business/physical location entered in Item 4
Address
City
State
Zip
7.
Required Confidential Telephone & Email Address:
Enter telephone number and email address.
Check here to have telephone and email
Telephone:
(
)
Email:
address made available to the public.
8.
Tangible Personal Property:
The business must provide information regarding their tangible personal property, which is used for
commercial purposes and may include office furniture, computers, tools, supplies, machines, and leasehold improvements (not real estate).
Check only one
A.
Tangible property exceeds $25,000 in value or leases any tangible property.
st
If Item A is checked, the applicant is required to file a Tangible Personal Property Tax Return with the Polk County Property Appraiser’s Office by April 1
.
B.
No tangible property.
C.
Tangible property does not exceed $25,000 in value.
If Item C is checked, the applicant is required to enter the business’ tangible personal property in the following table
Description of Tangible Property
Age of Item Year Acquired Original Cost
Note: If a business acquires Tangible Personal Property in excess of $25,000 in value, they must file a Tangible Personal Property Tax Return with the Polk County Property Appraiser’s Office.
09062013
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