Local Business Tax Form - City Of Jacksonville Beach

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City Clerk’s Office
C
J
B
ITY OF
ACKSONVILLE
EACH
rd
11 North 3
Street
Jacksonville Beach, FL 32250
LOCAL BUSINESS TAX FORM
(904) 247-6250
cityclerk@jaxbchfl.net
SECTION 1: Business Information
New
Transfer
Home Based Office Application Date:
Business Name:
Street Address:
Business Phone:
Mailing Address:
Email Address: ___________________________________________________________________________
SSN or FEIN
(Required per Florida Statutes, Ch. 205)
Business Operations/Description:
*
All Food Service Facilities must attach*: Public Works Dept. Grease Trap Inspection Report - call 247-6224
Fire Department Inspection Report - call 247-6239
Florida State DBPR Professional Certificate, Registration, or License Required
:
Yes
No
(Copy Attached)
Type:
#
Check all applicable boxes below and attach Florida Dept. of State - Div. of Corporations Documents to application:
Sole Proprietor
Partnership
Corporation
LLC
Fictitious Name Registration
SECTION 2: Business Owner/Applicant Information
Name:
Copy of Photo ID Attached
Home Address:
Home Phone:
Alternate Phone:
SECTION 3: Certification
I certify that all information contained herein is true and correct to the best of my knowledge and belief.
I understand that any false or misleading information on this tax form, failure to pay the required local
business tax, or failure to comply with the City of Jacksonville Beach Code of Ordinances regulating the
operation of local businesses may be cause for revocation of the privilege to operate this business within
the city limits of Jacksonville Beach.
Signature of Applicant:
Date:
SECTION 4: City Clerk’s Office
Control #
LBT Receipt #
Cash
Check #
SIC Code(s):
Annual LB Tax
$
Home Occ. Permit Fee $
Half Year LB Tax
$
Transfer Fee
$
Received by:
Date:
SECTION 5: Planning and Development - LDC Compliance
:
:
:
Yes
Zoning Classification
Business/Occupation
Permitted Use
Subject to Home Occupation Regulations
No
(Code of Ordinances - LDC 34-399)
Subject to Sign Standards and Permit Regulations
(Code of Ordinances - LDC 34-441)
Other:
Reviewed by:
Date:

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