Application For Brevard County Business Tax Receipt (Page 3 of 3) in pdf

Application For Brevard County Business Tax Receipt Page 3

OWNER AUTHORIZATION FORM

This form is not required if the applicant is the owner of the property for which the business tax receipt is being

applied. Complete section (1) or provide proof of authorization to use the subject property with any one of the

documents listed below under Section (2)

SECTION (1)

APPLICANT’S NAME: _____________________________________________________________________________

BUSINESS NAME: _________________________________________________________________________________

PROPERTY OWNERS NAME: _______________________________________________________________________

PROPERTY ADDRESS: _____________________________________________________________________________

PROPERTY DESCRIPTION:

_____TOWNSHIP _____RANGE ______SECTION ______SUBDIVISION ______PARCEL/BLOCK _____LOT

NATURE OF BUSINESS: ___________________________________________________________________________

I, __________________________________, as the owner/legal representative of the above described property, and

having the authority of same, do authorize the aforementioned Applicant and Business to utilize this property location to

operate said business.

UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT

AND THAT THE FACTS STATED IN IT ARE TRUE.

_____________________________________________

Owner/Legal Representative

ANY PERSON FALSIFYING DOCUMENTS OR PROVIDING FALSE INFORMATION FOR THE PURPOSE OF OBTAINING

ZONING APPROVAL FOR A BUSINESS TAX RECEIPT SHALL BE SUBJECT TO PROSECUTION AND A FINE NOT TO

EXCEED $500 OR IMPROISONMENT IN THE COUNTY JAIL FOR A PERIOD NOT TO EXCEED 60 DAYS, OR BOTH SUCH

FINE AND IMPRISONMENT

SECTION (2)

As an alternative to Section (1), provide any ONE of the following documents:

A) Notarized letter from the owner of record

B) Current copy of a lease agreement

C) Copy of a contract

D) Other pertinent data that authorizes use of the property

(updated

6/27/2012)

Application For Brevard County Business Tax Receipt Page 3