HomeMy WebLinkAboutHandouts_Regular_AOM _07/14/2011 Council Member Humpage �P` � rE ijILI.AGE �F TEQi7EST'A
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° � , DEPARTMENT OF COMMUNITY DEVELOPMENT
9 � a 345 Tequesta Drive • Tequesta, Florida 334G9-0273
r a a � (5G1.) 575-6220 • Fax: (5G1) 575-6224
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RETAIL INVENTORY AFFIDAVIT FOR FY 2011-2012
Date: 7/07/2011 "" '
P'`� �'c'� t _ � �•�-� � � ..� �? � ��v, ""
� �rt. �a s� � - ��r�,�c fv /� r'7 � - .. - � .� oD , .�
Local Business Tax Receipt: 554 "� � -�-•. .�`"��� �° ,
`S'� N)n dF�+'��' �� " �� 7`O �t3� >� � .,.�,�
STOP N SHOP � r�, u c� �� '- p � �'� � �'Q '� � � �� � ~
� 391 SEABROOK RD
TEQUESTA, FL 33469
----- -- As (? ow:�er or_( )_�ent of 1 -_..._�.--�-_.
� I cert"ify that the value of the inventory of rnerchandise for ihis business at the end of the 2010 ~
calendar year and reported to the Intemal Revenue Service was:
$
--OR--- If the business started after December 31, 2010, the inventory value 60 days after the
issuance of the business tax receipt was:
$
Signature �
Printed or Typed Name
PLEASE COMPLETE THIS AFFIDAVIT AND RETURN IT TO THE COMMUNITY �
DEVELOPMENT DEPARTMENT, AT THE ABOVE ADDRESS BY JULY 25, 2011. FAILURE TO
RESPOND WILL CAUSE YOUR BUSINESS TO BE TAXED AT THE HIGHEST RATE OF -
$650.00.
The foregoing instrument was acknowledged before me this day of
Date
bY _who is personally known
Month Name of person acknowledging
To me or who has produced as identification.
Type of identification
Notary Public
Signature of Notary Public
STATEOF ,Seal}
State where notarized
If you have any questions, please call Maureen McGuinniss at 561-768-0454
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