2013 Delinquent Business License Renewal Application Form - City Of Alexandria, Virginia
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2City of Alexandria, Virginia
2013 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)
Individual
Corporation
LLC
S Corp
Partnership
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.
Business Trade Name: ______________________________________________________________________________________
Taxpayer Identification Number: _____________________________________________________________________________
(Fed. ID or Soc. Sec. #)
Business Location:
_____________________________________________________________________________
(Street)
(Suite or Apt#)
_____________________________________________________________________________
(City)
(State)
(Zip Code)
Business Telephone # (____) ________-____________________________ Fax # (_____) _________-_______________________
Date Business Began in Alexandria: _____/______/________ Number of Employees in Alexandria: ______________________
Description of Business: _________________________________ License Type: _______________________________________
Do you own a vehicle(s) that is used ___________________________________________________________________________
(Attach an additional page if you have more than one vehicle.)
for business purposes?
Vehicle Identification Number:
___________________________________Percentage of Business Use: _________________
Business Mailing Address: __________________________________________________________________________________
(Street)
(Suite or Apt#)
__________________________________________________________________________________
(City)
(State)
(Zip Code)
Bank Name:
_____________________________ E-Mail Address: _______________________________________
2013 Estimated Gross Receipts (If applicable): ________________________________
License Year
Gross Receipts
Tax Rate
Tax Due
Penalty
Interest
Total Due
(Tax Year)
10%
10%
2013
2012
2012
2011
2011
2010
2010
2009
Signature: _______________________________________________ Date: ________________________________________________
(An original signature of owner or authorized corporate representative is required.)
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Parent category: Legal