Worker'S Compensation Insurance Certification Business License Addendum Form - City Of Fulton Page 2
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2BUSINESS LICENSE RENEWAL APPLICATION
MARCH 1, 2016 THROUGH FEBRUARY 28, 2017
Business Name: ___________________________________________________________________________________
Business Location Address: __________________________________________________________________________
Mailing Address: __________________________________________________________________________________
Business Phone: ___________________ After Hours Phone: _________________ E-mail: _______________________
Type of Business: __________________________________________________________________________________
Owner/Manager: ______________________________________ Phone Number: _______________________________
Owner’s Home Address: _____________________________________________________________________________
Owner’s SS#: _________________________________ Owner’s Date of Birth: _________________________________
Emergency Contact: ________________________________ Phone Number: ___________________________________
1. Did you have a business license for any portion of the period from March 1st through February 28th of the previous
year?
___YES
___NO
Business Insurance Company: _________________________________
2. Does your business collect retail sales tax? ___YES ___NO
3. Missouri Tax Identification Number: _______________________________ (All businesses required to collect retail
sales tax must provide this number. This is the eight digit number on your state sales tax license.)
Sec. 22-106 Tax: All businesses operating within the City of Fulton shall pay the following tax based on the total gross
receipts from the previous calendar year.
FEES: Circle One
$50,000 or less……….… $ 25.00
$300,000 to 400,000……$200.00
$50,000 to 100,000…….. $ 50.00
$400,000 to 500,000……$250.00
$100,000 to 200,000….... $100.00
$500,000 to 1,000,000….$300.00
$200,000 to 300,000….... $150.00
over $1,000,000…….…..$350.00
For each and every month or fraction thereof, except the month of March, that any license tax that remains unpaid, after
such becomes due and payable, there shall be added to such license a delinquency fee of 5% per month of the amount of
the license tax. The penalty herein provided shall be in addition to all other penalties elsewhere provided for the violation
of the provisions of the licensing ordinance.
I certify that all the above information is correct.
___________________________________________________
______/____/______
Authorized Signature
Date
1.
Corporate application must be signed by an officer of the corporation.
2.
Changes in the status of this license must be forwarded to the City Clerk.
3.
Contact the City Clerk’s Office at (573)592-3111 or P.O. Box 130, Fulton, MO 65251 if you do not intend to renew your license.
* The following items must be returned to receive your license *
COMPLETED APPLICATION
RENEWAL FEE (BASED ON GROSS RECEIPTS)
A COPY OF YOUR 2015 PAID COUNTY TAX RECEIPTS (PERSONAL AND PROPERTY)
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