Gross Receipts For 2015 - Renewal

STATEMENT OF GROSS ANNUAL RECEIPTS

YOUR OCCUPATIONAL LICENSE IS EXPIRING

Please complete and return this form to complete your renewal of your occupational license. To ensure receipt of a new license please return the documents requested in the accompanying letter along with payment (fees on reverse side).

 

Name of Business:
Owner:
State Drivers Lic #:
Date of Birth:
E-mail:
New Address (Only if it has Changed Since Last Year):
We are no longer in business:

PLEASE INDICATE BELOW YOUR GROSS RECEIPTS* ENDING DECEMBER 31, 2014 OR YOUR LAST FISCAL YEAR. IF YOU HAVE NOT BEEN IN BUSINESS FOR A FULL YEAR, PLEASE LIST THE GROSS RECEIPTS YOU HAVE ACCUMULATED AND INDICATE THE TIME FRAME.

I HEREBY CERTIFY THAT THE TOTAL GROSS RECEIPTS ON THE ABOVE ADDRESS ARE:

$:
Title:
signature:
Date:

*For Business located within Raytown: use the TOTAL GROSS REVENUE generated by your company BEFORE ANY DEDUCTIONS are made for expenses commissions, taxes or any other items.

*For Business located outside of Raytown Use the TOTAL GROSS REVENUE generated by your company IN THE CITY OF RAYTOWN before any deductions are made for expenses, commissions, taxes, or any other items.

Vending machines include snacks, soda, candy, cigarettes, video games, copy machines and any machine that money is placed into. DO NOT INCLUDE LOTTERY TICKET MACHINES OR NON-PROFIT MACHINES.

Number of vending machines?:
If you plan on selling tobacco-related paraphernalia per City Ordinance, you must have at least 70% of your sales in tobacco. 
Do you plan on selling paraphernalia?:
What percent of sales is tobacco?:


Official Website of the City of Raytown, Missouri
City Hall | 10000 East 59th Street | Raytown, Missouri | 64133 | Ph (816) 737-6000
Office Hours: Mon - Fri 8:00am - 5:00pm