Business Tax Receipt Registration - Rental Property Owner

							                                             City of Leesburg
                                      Rental Property Owner
                                 Business Tax Receipt Registration
                                   Phone (352) 728-9818, Fax (352)728-9734
     501 W. Meadow St./ P O Box 490630/Leesburg, Fl 34749-0630     E-mail: tammy.reier@leesburgflorida.gov


1. NAME OF PROPERTY OWNER __________________________________________________________
     _____ Incorporated _____Partnership _____ Fictitious Name _____Sole Proprietor /Person/Landlord

2. PROPERTY OWNER’S ADDRESS: ________________________________________________________

        CITY __________________________ ST ____ ZIP ____________ PHONE NO._______________

             DRIVERS LICENSE # ____________________________ DATE OF BIRTH ________________
                                                                                                (DD/MM/YYYY)
                           SSN ________________________ or FEDERAL ID ________________________

3. MAILING ADDRESS FOR RENEWALS ______________________________________ ZIP __________

                IF APPLICABLE, IN CARE OF NAME ____________________________________________

4. EMERGENCY CONTACT NAME ________________________________ PHONE # __________________

5. ____ NEW PROPERTY OWNER             ____ ADD NEW PROPERTIES TO EXISTING BUSINESS

6. I AM THE OWNER OF THE FOLLOWING RENTAL PROPERTIES:
   (USE REVERSE SIDE IF MORE SPACE IS NEEDED)
  _____________________________________________________________________________________________

  _____________________________________________________________________________________________

  _____________________________________________________________________________________________

  _____________________________________________________________________________________________

  _____________________________________________________________________________________________

  _____________________________________________________________________________________________

  TOTAL # OF PROPERTIES _______ (1-15 units $26.25 / 16-50 units $42.00      /   51 or more $73.50)

  I CERTIFY THE ABOVE INFORMATION IS CORRECT.

  APPLICANT SIGNATURE______________________________________________________DATE_____________



NOTIFY THIS OFFICE IMMEDIATELY IF YOU CHANGE YOUR NAME, ADDRESS, SERVICES,
TELEPHONE NUMBERS, OWNERSHIP, ETC.




FOR OFFICE USE ONLY

TAX CLASSIFICATION ___________________ FEE AMOUNT_____________ RECEIPT #______________

CONTROL # ________________________ TRANSFERED FROM CONTROL # _________________________

ISSUED BY: ________________________________________     DATE: ___________________