St. Lucie County Affidavit by PermitDocsPrivate

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									                                                 Bob Davis, CPA, CGFO, CFC
                                                   St. Lucie County Tax Collector
                                             P.O. Box 308 Fort Pierce, Florida 34954-0308
                                                       Website: www.tcslc.com
                                                    Email: taxcollector@tcslc.com
FORT PIERCE                                                                                                     PORT ST. LUCIE
County Administration Bldg.                                                                                     1664 SE Walton Road
2300 Virginia Avenue                                                                                            Suite 101
Fort Pierce, FL 34982-5632                                                                                      Port St. Lucie, FL 34952-7656
(772) 462-1650                                                                                                  (772) 462-1650
Fax (772) 462-1468                                                                                              Fax (772) 337-5624


                                                         AFFIDAVIT
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  NAME OF BUSINESS OR INDIVIDUAL:




                  I am doing business under my incorporated name.

                  I am licensed by the Department of Business and Professional Regulations.

                  I am the only owner and am using my legal name.

                  I am using a Fictitious Name.

                  I am exempt from State Fictitious Name Registration.

                  I am licensed by the Department of Agriculture & Consumer Services

                  I am licensed by the Department of Hotels & Restaurants.

                  I am licensed by the Florida Bar Association.

                  I am licensed by Medical Quality Assurance.

                  I am licensed by the Florida Department of Financial Services.




    Signature                                                     Title                                         Date




                                                                                                                                   REV 1-11


                REAL ESTATE AND PERSONAL PROPERTY TAXES ~ MOTOR VEHICLES, VESSELS & MOBILE HOMES ~ ALARM PERMITS
                   HUNTING, FISHING & TRAPPING LICENSES ~ LOCAL BUSINESS TAX RECEIPTS ~ TOURIST DEVELOPMENT TAX

								
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