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Application To Make Periodic Payments Of Telecommunications Taxes - City Of Gainesville

APPLICATION TO MAKE PERIODIC PAYMENTS

OF TELECOMMUNICATIONS TAXES

CITY OF GAINESVILLE, FLORIDA

THE CITY OF GAINESVILLE WILL PERMIT TELECOMMUNICATIONS TAXPAYERS WHOSE ANNUAL LIABILITY IS

PROJECTED TO BE LESS THAN $2,500 PER YEAR TO PAY TELECOMMUNICATIONS TAXES AS FOLLOWS:

ANNUAL TAXES ESTIMATED TO BE LESS THAN $1,000 - REPORT AND PAY ANNUALLY

ANNUAL TAXES ESTIMATED TO BE $1,000 OR MORE BUT LESS THAN $2,500 - REPORT AND PAY QUARTERLY

I (We) hereby make application to the City of Gainesville to pay telecommunications taxes ____________________Annually

____________________Quarterly

I (We) anticipate that telecommunications taxes due to the City of Gainesville for the period beginning

October 1, __________and ending September 30, __________, will be less than the limit stated above.

I (We) understand that this application must be filed on an annual basis no later than September 30, and that monthly payments

must resume if a merger, acquisition or other change in the nature of our business results in a tax liability that exceeds

the limits stated above.

_________________________________________________

_______________________________________________

Name - Please Print

Title

_________________________________________________

_______________________________________________

Company Name

Telephone Number

_________________________________________________

_______________________________________________

Street Address

City State Zip

_______________________________________________

Signature

Application To Make Periodic Payments Of Telecommunications Taxes - City Of Gainesville