I, __________________________________, whose current legal residence is
__________________________________________, declare that I grow/catch
my own produce/seafood and that I intend to peddle the same in the City of
Norfolk. I have applied to the business tax team of the Commissioner of the
Revenue’s office and have been informed that under State Code 58.1-3719 this
type of business activity is not required to purchase a license.
I further understand that the penalties involved for making a false statement is a Class 1
misdemeanor and is punishable by a fine of nor more than $2,500 and/or confinement in
jail for no more than 12 months (City Code 24.25.3, 1-11).
This affidavit is valid for the person named above during the business license year
________ and will expire on December 31, __________.
(Signature of Applicant) (Date)
Subscribed and sworn before me this ________day of ___________, _____, by
My commission expires: ____________________________________