Business License Tax Return Form 2005 - State Of Virginia
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1MAIL THIS RETURN TO:
2005
Commissioner of Revenue
Arlington County
2100 Clarendon Boulevard. Suite 208
Arlington, VA 22201
Ingrid H. Morroy, Commissioner of Revenue
Due by MARCH 1, 2005
To Avoid Penalty and Interest
BUSINESS LICENSE TAX RETURN
For information please contact:
Phone (703)228-3060
e-mail: business@arlingtonva.us
ACCOUNT#
________________________________
**IF NO LONGER IN BUSINESS:
ENTER DATE CEASED:____________________ $
2004 Gross Receipts: ______________________
Successor’s Name and address (if applicable) ____________________________________________________________________________________
Part 1: APPLICANT INFORMATION (make corrections below as needed)
APPLICANT NAME:
FEIN OR SSN:
__________________________________________________________
______________________________________
Square Footage of Arlington Office:
__________________________________________________________
_______________________
MAILING ADDRESS
Number of employees in Arlington:
__________________________________________________________
_____________________
CITY, STATE, ZIP
Check here if Arlington business is residence:
__________________________________________________________
Check
this box if any changes were made to applicant name or mailing address in Part 1.
PART 2: BUSINESS INFORMATION
ARLINGTON COUNTY BUSINESS ADDRESS
ZIP CODE
LOCAL BUSINESS TELEPHONE
________________________________________________________
____________
________________________________________________
DETAILED DESCRIPTION OF BUSINESS
START DATE
ARLINGTON CODE TITLE
&
SECTION/DETAIL
________________________________________________________
____________
_________________________________________________
TRADE NAME USED
STATE OF INCORPORATION
DATE OF INCORPORATION
________________________________________________________
______________________________
_____________________________
[ ] INDIVIDUAL
[ ] PARTNERSHIP
[ ] CORPORATION
[ ] LLC
[ ] NON-PROFIT
[ ] OTHER
___________________
(specify)
CONTACT PERSON (NAME & TITLE)
TELEPHONE
E-MAIL ADDRESS
________________________________________________________
_________________________________
______________________________
Check this box if any changes were made to Arlington County business address in Part 2.
PART 3: CALCULATION OF TAX
A.
Step 1 License basis (rounded to the nearest dollar)
. 0 0
Business which began in Arlington after 1/1/2004
o
1) enter 2004 gross receipts here
_________________________
2) enter estimated 2005 gross receipts in section A
Businesses which began in Arlington on 1/1/2004 or prior, enter 2004 gross receipts in section A
o
B.
Step 2 Tax Rate
Enter tax rate from Table B on reverse side in section B
____________________
Step 3 Tax Due
Installments (see reverse for qualification and instructions) check here
C.
If section A is less than or equal to $100,000, enter flat fee amount from Table A on reverse side in section C.
o
If section A is greater than $100,000, multiply boxes A and B and enter result in section C.
______________________
o
If license is not based on gross receipts, enter flat tax from Table C on reverse side in section C.
o
D.
Step 4 Late Payment Penalty (if applicable) Instructions on reverse.
Enter 10% of section C in section D
______________________
E.
Step 5 Total Amount Due
Add sections C and D, enter sum in section E.
___________________
PART 4 METHOD OF PAYMENT
CHECK payable to “Treasurer, Arlington County”
CREDIT CARD BY PHONE**
INTERNET (E-CHECK OR CREDIT CARD)**
____
____
____
** For information and instructions on credit card and e-check payment options, go to:
I, the undersigned, do affirm that the foregoing information is true and correct to the best of my knowledge.
Print Name
Day Time Telephone (
)
Signature
Date
e-mail address
Please keep a copy for your records
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