Business Privilege Tax Form - Township Of Palmer
ADVERTISEMENT
1
2LICENSE AND TAX PAYABLE TO
TOWNSHIP OF PALMER
MUNICIPAL BUILDING
3 Weller PI
PO
BOX 3039
PALMER
PA
18043 3039
610 253 7191
TOWNSHIP OF
PALMER
BUSINESS PRIVILEGE TAX
SEE PAYMENT
INFORMATION
ON REVERSE SIDE
I
I
ACCOUNT NUMBER
FOR LICENSE YEAR
DUE DATE
I
PENALTIES of 5
plus
1
per month will be
charged
on
payments
I
declare
under the
penalties
of
perjury
that the
return
listed
received after due date
below has
been examined
by
me
and
to
the best of
my
knowledge
Additional forms ordinances
or
regulations supplies
upon
and belief is
a
true
correct
and
complete
return
OWNER
TYPED
OR PRINTED TITLE OF PERSON PREPARING FORM
request
to
MUNICIPAL BUILDING
3 Weller PI
P O BOX 3039
AUTHORIZED SIGNATURE
PALMER PA 18043 3039
DATE
NOTE
GROSS
VOLUME
b
a
c
d
SERVICE
Ie
Indicate volume of business transacted
in
each
municipality
WHOlESALE
RETAIL
and
or
TOTAL
RENTALS
GROSS VOLUME OF BUSINESS
PRIOR YEAR
I
TAX RATE
001
00150
00150
TOTAL
AMOUNT
OF TAX
1
J
I
PENAlTIES IF APPliCABlE
TOTAL AMOUNT OF TAX DUE
l
r
Breakdown of Column d
l
ADDRESSES OF RENTAL UNITS
Use additional sheets if
necessaryl
L
2
GROSS RECEIPTS
GROSS RECEIPTS
TOTAL GROSS RECEIPTS OF RENTALS
Payment
Received
as
Certified Below
Tax
OHicer
OFFICE COPY
LICENSE AND TAX PAYABLE TO
TOWNSHIP OF PALMER
MUNICIPAL BUILDING
3 Weller
PI
POBOX 3039
PALMER
PA 18043 3039
61 0
253 7 1 91
ACCOUNTNUMBER
I
PENALTIES of 5
plus
1
per month
will be
charged
on
payments
received after
due date
Additional forms ordinances
or
regulations supplies
upon
request
to
MUNICIPAL BUILDING
3 Weller PI
P O BOX 3039
PALMER PA 18043 3039
TOWNSHIP OF
PALMER
BUSINESS PRIVILEGE
TAX
SEE PAYMENT
INFORMATION
ON REVERSE SIDE
r
DUE DATE
FOR
LICENSE YEAR
I
declare
under
the
penalties
of
perjury
that the
return
listed
below
has been examined
by
me
and
to
the
best of
my
knowledge
and belief is
a
true
correct
and
complete
return
OWNER
TYPED
OR
PRINTEDI
TITLE OF PERSON PREPARING FORM
AUTHORIZED SIGNATURE
DATE
GROSS VOLUME
d
SERVICE
RETAIL
and
or
RENTALS
e
NOTE
a
b
c
TOTAL
WHOLESALE
Indicate volume of business transacted
in
each
munici
ali
GROSS VOLUME OF
BUSINESS
PRIOR YEAR
t
r
t
I
TAX RATE
001
00150
l
TOTAl
AMOUNT OF TAX
PENAlTIES IF
APPliCABLE
TOTAL AMOUNT OF TAX DUE
Breakdown of Column d
l
ADDRESSES OF RENTAL UNITS
Use additional sheets if
necessaryl
1
2
GROSS RECEIPTS
GROSS RECEIPTS
TOTAL GROSS RECEIPTS OF RENTALS
Payment
Received
as
Certified Below
Tax
OHicer
CUSTOMER COpy
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