Application For Certification As A Short-Term Rental Business Form - City Of Norfolk, Virginia
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1
2City of Norfolk
C. Evans Poston, Jr., Commissioner of the Revenue
Application for Certification
As a Short-term Rental Business
Section 1 – To be completed by business owner (for each location)
Applicant Name
________________________________________________________
Trade Name
________________________________________________________
Business Location
________________________________________________________
Mailing Address
________________________________________________________
Telephone Number
________________________________________________________
Business Tax Contact
________________________________________________________
Date Business Began in City of Norfolk
________________________________________________________
Type of Rental Property
________________________________________________________
Federal Tax Identification Number
________________________________________________________
Virginia Sales Tax Number
________________________________________________________
THE FOLLOWING INFORMATION MUST BE COMPLETED:
The gross receipts reported should be for the 12-month period reported on your last City of Norfolk Business License.
1. Total Gross Receipts for the Period Indicated
___________________________________________
2. Total Gross Rental Receipts for the Period Indicated
___________________________________________
3. Total Gross Proceeds from Short-term Rental
___________________________________________
4. Total Gross Receipts from Short-term Rental Property
Leased to a Person Affiliated with the Lessor
___________________________________________
5. Adjusted Daily Short-term Rental Proceeds
(Subtract line 4 from line 3)
___________________________________________
CERTIFICATION:
I, the undersigned, hereby certify under penalty of perjury that the information provided
herein is true and accurate to the best of my knowledge and belief.
_______________________________________________________________________
Signature
Title
Date
Section 2 – To be completed by Commissioner of the Revenue
Date Received ________________
Approved ____________________
Not Approved _________________
Date
Date
Business Acct. #: ______________
___________________________________________________________
Business Tax Coordinator
Date
For further information, call (757)664-7886
Website:
Mail completed form to:
C. Evans Poston, Jr., Commissioner of the Revenue, P.O. Box 2260, Norfolk, VA 23501-2260
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