Delinquent Business License Renewal Application Form - Virginia - 2016
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1
2City of Alexandria, Virginia
2016 Delinquent Business License Renewal Application
P.O. Box 178, Alexandria, VA 22313
703.746.3903
#:_____________________
License
Owner’s Name:
___________________________________________________________________________________________
Owner’s Address:
____________________________________________________________________________
(Street)
(Suite or Apt #)
____________________________________________________________________________
(City)
(State)
(Zip Code)
S Corp
Partnership
Individual
Corporation
LLC
.
If partnership, provide on a separate sheet of paper the names and addresses of the other partners
.
If Corporation, provide name and address of Registered Agent
If LLC, provide member’s name and social security number.
_____________________________________________________________________________
Business Trade Name:_
______________________________________________________________________
Taxpayer Identification Number:
(Federal Identification Number or Social Security Number)
______________________________________________________________________
Business Location:
(Street)
(Suite or Apt#)
______________________________________________________________________
(City)
(State)
(Zip Code)
Business Telephone # (____) ________-___________________________ Fax # (_____) _________-___________________________
Business Email Address: _________________________________________________________________________________________
_____/______/________
: ____________________
Date Business Began in Alexandria:
Number of Employees in Alexandria
_____________________________
________________________________
Description of Business:
License Type:
Business Mailing Address: _________________________________________________________________________________________
(Street)
(Suite or Apt#)
___________________________________________________________________________
(City)
(State)
(Zip Code)
_____________________________
Bank Name:
Do you own a vehicle(s) that is used for business purposes? (Check appropriate box)
If “Yes”, provide VIN and percentage of vehicle’s use for business.
Yes
No
Vehicle Identification Number:____________________________________ Percentage of Business Use:__________________________
(Attached an additional page, if you have more than one vehicle.)
______________________________
2016 Estimated Gross Receipts (If applicable):
License
Gross Receipts
Tax Rate
Tax Due
Late Payment
Interest
Total Due
10% per annum
Year
(Tax Year)
Penalty 10%
0.000274 daily
2016
(2015)
2015
(2014)
2014
(2013)
2013
(2012)
Signature: ______________________________________________ Date: __________________________________________________
(An original signature of owner or authorized corporate representative is required.)
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Parent category: Legal