CITY OF HUNTSVILLE, ALABAMA ANNUAL PRIVILEGE LICENSE TAX RETURN
FORM OF OWNERSHIP
OFFICE USE ONLY
¨ Sole Proprietor
o Partnership
Federal ID#____________________________________
ID#___________________________
¨ Corporation
o LLP
¨ LLC ¨ Other________________________
DL#_________________________________ ST______
Loc#___________________________
OWNER/OFFICER/MEMBER/PARTNER INFORMATION IS REQUIRED
Last/First/Middle ______________________________________
Last/First/Middle ______________________________________
Title ________________________________________________
Title ________________________________________________
Social Security Number_________________________________
Social Security Number_________________________________
DL#________________________________________ ST _____
DL#________________________________________ ST _____
Phone Number ________________________________________
Phone Number ________________________________________
Home Address ________________________________________
Home Address ________________________________________
City, State, Zip________________________________________
City, State, Zip________________________________________
TAXPAYER NAME (OWNING ENTITY)__________________________________________________________________________________________________
DOING BUSINESS AS (DBA)____________________________________________________________________________________________________________
PERSON RESPONSIBLE FOR LICENSE____________________________________________________________ PHONE (_______) ___________________
MAILING ADDRESS____________________________________________________________________________________UNIT / SUITE ___________________
CITY _________________________________________________________________________________STATE ____________ ZIP ____________ +4 _________
LOCATION ADDRESS_______________________________________________________________________________________UNIT / SUITE ______________
CITY ______________________________________________ STATE ____________ ZIP __________ +4 _________ PHONE (_______) ___________________
DATE BUSINESS BEGAN_______________________________________________DATE APPLIED__________________________________________________
PREVIOUS OWNER’S NAME_________________________________________________________________ TAXPAYER NUMBER ____________________
TYPE OF BUSINESS ____________________________________________________________________________________________________________________
TYPE OF PRODUCT ___________________________________________________________________________________________________________________
SEE MUNICIPAL CODE FOR SCHEDULE NUMBERS, LICENSE FEES, LATE FEES, AND COMPUTATIONS. (CHAPTER 15)
GROSS RECEIPTS AND COMPUTATION PER SCHEDULE:
AMOUNT DUE PER SCHEDULE
SCH#__________ NAICS CODE_____________________ $ _______________________________________________ $ ________________________ .______
SCH#__________ NAICS CODE_____________________ $ _______________________________________________ $ ________________________ .______
SCH#__________ NAICS CODE_____________________ $ _______________________________________________ $ ________________________ ._______
SCH#__________ NAICS CODE_____________________ $ _______________________________________________ $ ________________________ . _______
USE THIS SPACE FOR ADJUSTMENT COMPUTATION ONLY:
YEAR ________ SCH#_________ $__________________________________________________________________ $ _________________________._______
YEAR ________ SCH#_________ $__________________________________________________________________ $ _________________________._______
ADJUSTMENT SUB TOTAL +/-
$ _________________________._______
PENALTY COMPUTATION
TOTAL TAX DUE
$_________________________._______
1st 30 days penalty is 15% of the license fee
INTEREST
$_________________________._______
(CALL FOR CURRENT RATE)
(State Code 11-51-93)
PENALTY
$_________________________._______
After 30 days the penalty is 30% of the license fee
12 00
ISSUING FEE
$_________________________._______
(State Code 11-51-93)
TOTAL AMOUNT DUE
$_________________________._______
I swear and affirm that the above is a true and correct statement to the best of my knowledge and belief. THIS FORM MUST BE SIGNED.
_________________
_______________________________________________________
__________________________
DATE
SIGNATURE
TITLE
MAIL TO: CITY CLERK-TREASURER, P.O. BOX 308, HUNTSVILLE, AL., 35804-0308
BRING TO: CITY MUNICIPAL BUILDING, 3RD FLOOR, 308 FOUNTAIN CIRCLE, HUNTSVILLE, AL 35801
TELEPHONE (256) 427-5082
(RENEWALS ARE DUE AND PAYABLE ON JANUARY 1, AND DELINQUENT AFTER JANUARY 31 OF EACH YEAR.)
Rev. 11/13