2017 BUSINESS LICENSE RENEWAL AFFIDAVIT 

                      Business licenses expire on December 31 

Taxpayer ID 

# _____ _ 

  Business Name, _________________________ _ 

  Mailing Address  ________________________ _ 

  Phone Number     _________________________ _ 

  Contact Person   _________________________ _ 

  Please note that most license fees are based 011 a gross receipts ammmt.  This amount must 
  include all revenue collected from January 1 through December 31 of each prior calendar 
  year. 

  Please indicate your gross receipts amount here  $ ____________ _ 

                                               or 

  Number  employeesof   ______(if license fee is based on employee count) 

  I hereby certify that the information provided on this affidavit is true and correct to the 
  best of my knowledge. 

                                                   Signature 

                                                   Title 

                                                   Date 

  For a copy of your fee schedule and/or assistance in calculating your license fee, please 
  contact Tracie Roybal at (205) 274-2135.