Business Privilege License
Application – Appendix A – Statement of Gross Receipts
For Renewal by Gross Receipts Licensees ONLY !!
Use this form to declare your gross receipts and to calculate the amount of license fee due based on those gross receipts.
Business Name: ______________________________________ Business ID______________
|
Line |
Column A |
Column B |
||
| 1. | In Column A, enter the amount of receipts from the sale of all tangible personal property during the license year ending September 30. |
______________ |
XXXXXXXXXXXXXXXXXXXXX |
XXXXXXX |
| 2. | Minimum amounts for "gross receipts license" calculation method. |
10,000.00 |
XXXXXXXXXXXXXXXXXXXXX |
35.00 |
| 3. | In Column A, Subtract the amount on Line 2 from the amount on Line 1 (If less than "zero", enter "0"). |
______________ |
Multiply the amount in Column A by .000625 and enter the lesser of the result or $31.25 in Column B. |
__________ |
| 4. | Secondary threshold amount for license fee calculation. |
60,000.00 |
XXXXXXXXXXXXXXXXXXXXX |
XXXXXXX |
| 5. | In Column A, Subtract the amount on Line 4 from the amount on Line 1 (if less than "zero", enter "0"). |
______________ |
Multiply the amount in Column A by .0005 and enter the result in Column B. |
___________ |
| 6. |
Total of the amounts in Column B, Lines 2, 3, and 5: Gross Receipts License Fee Due |
___________ |
||
| 7. |
Issuance Fee |
5.00 |
||
| 8. |
Total of the
amounts in Column B, Lines 6, 7, and 8 |
$___________ |
||
Under penalty of perjury, I declare that I have
examined the information included herein and to the best of my knowledge and
belief, it is true, correct and complete. My
signature indicates that I take full responsibility for this application and any
tax liability and/or penalty that might occur or be imposed as the result of
business activities in the Town of Collinsville, Alabama as related to the
business for which license is applied for.
Print Name
of Owner, Partner, or Officer__________________________________________ Title
_________________________
(or
other responsible person)
Signature of Owner, Partner, or Officer
__________________________________________ Date
_________________________
(or
other responsible person)
Privacy Notice: The
information provided herein is made available only to those specifically
authorized and responsible for the administration and enforcement of the
Town’s Business Privilege License Ordinance and other related regulation and
is not released or otherwise provided to any other person or agency except by
order of a court of competent jurisdiction.