Ocam Pa01 - Business Volume Declaration
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4Commonwealth of Puerto Rico
OCAM PA01 REV 2014
Business Volume Declaration
Municipality of
San Juan
For Calendar Year 20
or other taxable year from
20
to
20
Please complete the following information:
Employer Social Security Number
Type of License
Municipal Identification Number
Fiscal Year Business Telephone Number
Normal
Exempt
Executed
Name of D/B/A
Seg. Soc. of Owner o Representative of Reg. Inc.
Name of Individual, Industry, Business
New Address?
Physical Address
Zip Code
YES
NO
Industry, Business or Service Class
Num. of Employees
Annual Payroll
Date Business was established:
Type of Business
Indiv.
Soc.
Corp.
$
MM:
DD:
YR:
Owner or Representative’s Name
Owner or Representative’s Position
¿Radicó usted Declaración de Volumen de
Negocios el año pasado?
YES
NO
Mailing Address
Zip Code
New Address?
YES
NO
Owner or Representative’s Home Address
Zip Code
New Address?
YES
NO
Mailing Address of Businesses’ Main Office
Zip Code
New Address?
YES
NO
Business Volume (Schedule 6, Line 27, Page 3) .........................................................................................................................
$
Municipal Tax rate (Schedule 6, Line 29, Page 3) .......................................................................................................................
License Tax Due (Schedule 6, Line 30, Page 3) ..........................................................................................................................
Penalties (Schedule 6, Line 32, Page 3) ......................................................................................................................................
Discount (Schedule 6, Line 33, Page 3) ..............................................................................................................................
Credit for Similar Taxes paid outside of Puerto Rico ....................................................................................................................
(Schedule 6, Line 34, Page 3)
Total Tax Due (Schedule 6, Line 35, Page 3) .............................................................................................................................
$
C e r t i f i c a t i o n
I certify, that the Business Volume hereby declared has been calculated following the provisions of Act 113 of July 10, 1974, as amended, known as the Municipal
License Tax Act; that the financials attached are in accordance with the company’s accounting books as of
and that the copies
of pages and/or addendums to the Puerto Rico Income Tax Return are true and exact duplicates of those submitted to the Treasury Department.
Taxpayer’s Signature or Authorized Agent
Date
O A T H
Taxpayer or Authorized Representative’s Signature:
Aff. #
Sworn and subscribed before me by
of legal age and resident of
, Puerto Rico whom I personally know or am able to
identify by means of reliable alternate resources today, ___________________________ in the city of
________________, Puerto Rico.
Notarial
Seal
Signature of Officer Administering Oath
Title of Officer Administering Oath
See instructions on Page 4 before completing this Declaration.
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