Business Privilege Tax Return Form - 2016

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BUSINESS PRIVILEGE TAX RETURN
2016
TOWNSHIP OF SPRINGFIELD
DUE 5/31/16
50 Powell Road
Springfield, PA 19064
610-544-1300
Name of Business___________________________________________________________________________________________________
Business Address____________________________________________________________________________________________________
________________________________________________________________________________ Phone #___________________________
Name(s) of True Owners______________________________________________________________________________________________
Owner’s Address(es)_________________________________________________________________________________________________
________________________________________________________________________________ Phone #___________________________
Type of Business____________________________________________________________________________________________________
QUESTIONS
(Answer fully – use extra sheet if necessary)
1. Is this return based on a full year?
Yes
No
2. Date business started ___________________________________
3. If you terminated your business, give date ______________________________________
4. Do you lease any departments to others?
Yes
No
If “yes”, submit schedule showing details.
5. Number of employees at this location ____________________________________________
I DECLARE, UNDER PENALTY OF LAW, THAT ALL STATEMENTS MADE HEREIN AND/OR IN SUPPORTING
SCHEDULES ARE TRUE, CORRECT AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF
.
Signature
_________________________________________________________________________________________________
Official Title ___________________________________________________________________ Date_________________________
(OWNER, PARTNER, PRESIDENT, ETC.)
________________________________________________________________________________________________
SIGNATURE OF PERSON PREPARING RETURN – IF OTHER THAN TAXPAYER
_________________________________________________________________________________________________________________________________________
NAME AND ADDRESS OF PREPARER’S FIRM
TELEPHONE #
(PLEASE DETACH YOUR LICENSE BELOW AT THE PERFORATION)
2016
SPRINGFIELD TOWNSHIP – BUSINESS PRIVILEGE LICENSE
Account No.
(For the year May 31, 2016 to May 31, 2017)
This license is to be conspicuously displayed upon payment and is valid only for the above named business and is issued in accordance with Ordinance
No. 1024, enacted January 8, 1980 by the Township of Springfield, Delaware County, PA; under authority granted by the General Assembly of the
Commonwealth of Pennsylvania, approved December 31, 1965, P.L. 1257 as amended.
___________________________________
TOWNSHIP MANAGER

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