CITY AND COUNTY OF SUMTER
BUSINESS LICENSE DEPARTMENT
Mailing: P.O. Box 1449, Sumter, SC 29151
Physical: 12 W. Liberty St., Sumter, SC 29150
Phone: (803) 774-1601
Fax: (803) 774-1688
APPLICATION FOR PROFESSIONAL LICENSE
CLASSIFACTION CODE/CONTROL NUMBER:
____
___/___
____
Mailing Information:
Business Information:
Mailing Name:
Business Name:
_________
Mailing Address:
Location Address:
____________________________________
_____________________________________
____________________________________
_____________________________________
____________________________________
_____________________________________
Phone Number: _____________________
Emergency Information:
Federal Tax ID#: ____________________
Name: ______________________________
Officer of Firm: _____________________
Mailing Address:
_____________________________________
_____________________________________
_____________________________________
Phone Number: ______________________
GROSS FOR YEAR 20____:
$__
________
First $2,000 ……………………………………. $ __
PLUS
Over $2,000 ……………………………………. $ __
per thousand thereafter.
License Fee Due:
$ _______________
Previous Year’s Past Due/Penalty Amount: $___ ___________
TOTAL LICENSE FEE DUE:
$ _______________
This is to certify that the above is a true statement, and that this report corresponds with the records of the business and with the report
of same filed or to be filed, for the corresponding period with the South Carolina tax Commission or Insurance Commissioner. I
understand that the City/County Ordinance provides for penalties and license revocation for making false or fraudulent statements in
the applications and that an authorized agent of the Business License Department may examine and audit the books and records of the
applicant, including federal income tax records.
______________________________
_____________________________
________________________
SIGNATURE
TITLE
DATE
In Order to insure proper credit to your account
ALL CONCERNS ARE SUBJECT TO
you must return this prepared application.
AUDIT: REPORTED GROSS SUBJECT
Please verify all information listed, then
TO VERIFICATION WITH INTERNAL
complete this application.
REVENUE SERVICE.
_________________________________________________
REMITTANCE MUST ACCOMPANY APPLICATION
TH
TH
A PENALTY OF 5% PER MONTH WILL BE ADDED FOR NONPAYMENT BEGINNING FEBRUARY 16
(CITY)/MARCH 16
(COUNTY)
(Handled By: _____)