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CITY OF LONGWOOD
Community Development Department
174 W. Church Avenue, Longwood, FL 32750
(407) 260-3442
BTR RENEWALS
DUE EVERY YEAR:
10/01 - 09/30
City Office Use Only:
Administrative Fee

Transfer Fee

License Fee

County Fee

Total Amount
$ __________

$ __________

$ __________

$ __________

$ __________
Classification #

Location #

Control #

License #

Parcel #
__________

__________

__________

__________

__________
BUSINESS TAX RECEIPT APPLICATION
All 4 pages of this application must be completed in its entirety.
Reason for Application
*
New Business to the City
Change of Owner or Business Name
Transfer of Location
Home Occupation Business
At least one box must be marked.
BUSINESS INFORMATION: (Fill in or print clearly)
Business Name*
Contact Name (Site Manager/Emergency Contact)*
Business Address (including Suite or Apt. Number)*
Mailing Address*
City, State and Zip Code*
Business Phone Number*
Email Address*
Business Owner's Name*
Business Owners Phone Number*
Address
State License # (attach copy)
Federal I.D. # (attach copy)
Fictitious Name #: (attach copy)
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Step Two

Step Three

CORPORATE AND PARTNERSHIP INFORMATION:
Corporate Name
Corporate Document # (attach copy)
Address
City
State
Zip Code
Phone Number
Officers or Partners:
Name
Title
Home Address
Phone #
Date of Birth
Driver's License #
Name
Title
Address
Phone #
Date of Birth
Driver's License #
For questions on this application, please contact:
Kevin Cyman, Economic Development Coordinator (407) 263-2337 kcyman@longwoodfl.org
Business tax applications are applications are subject to Planning Division and Fire Department review.
For further information please contact:
Planning - Rachel Seliber, Community Development Coordinator (407) 260-3462 rseliber@longwoodfl.org
Fire Department - Jared Roberson, Fire Marshall (407) 260-3460
For information on business assistance call or email:
Tom Krueger, Economic Development Manager (407) 260-3430 tkrueger@longwoodfl.org
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Step Four

BUSINESS TAX RECEIPT APPLICATION
(continued)
Name
Phone
Mailing Address
Driver's License #
State registration from Sunbiz.org*
State license if business is State regulated
Being duly authorized to sign for the business named above, I do hereby make application for a Business Tax Receipt to engage in business within the City of Longwood, Florida. Under penalty of perjury, I certify that the foregoing information provided is true and correct to the best of my knowledge. I acknowledge that a Business Tax Receipt issued pursuant to this application does not waive requirements of any City, County, State or Federal ordinance, statute or regulation that I must meet prior to conducting, or while engaging in, the profession or business for which the Business Tax Receipt is sought. I have complied, or will comply, with all such requirements.
I specifically acknowledge that a Business Tax Receipt issued pursuant to this application does not grant the right to open, construct, alter, or add to a proposed business location, including the posting of advertising without proper permits and inspections, nor does issuance of the Business Tax Receipt constitute a certification that the proposed business location complies with applicable zoning, land development regulations or that the conditions of any other structure at the proposed location complies with applicable structure or technical codes.
I understand that it is my responsibility to verify and obtain applicable Building, Fire, and Planning/Zoning approval with the City of Longwood's Community Development and Fire Departments prior to commencing operations.
Electronic Signature Agreement
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
1. I agree.
Electronic Signature

Leave This Blank:

1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
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