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Aug.17.2009 01:21 PM SIMMONS *OVEN *CLEANING 6783778552 PAGE. 2/ 2 <br /> APPLICATION FOR B1.ISINESS TAX RECEIPT <br /> • PASCO COUNTY FLORIDA • <br /> TAX YEAR: 2009 -2010 ACCOUNT NUMBER: 074783 sic ('OI)H: <br /> CLEANING SERVICE 7349.06 <br /> 01IR FILES (.1 1RREN'I'I.,Y REFLECT THE I'OLLOWIN(, INFORMA'I'ION RIiI,ATIN(J'l'O'11IF BUSINESS IL)ENCII'IIiI) BELOW. <br /> PLEASE ('I IANGE INCORRECT INFORMATION. <br /> th Itu;aness Nano• Or I' oitin(IS Name: SIMMONS OVENS RESTAURANT CLEANING INC <br /> Il'Fictitious Name, Registration Number: EXEMPT Expires: <br /> • (. nrporatt; Name (II OiIIeient from Abovel: <br /> • Owner /Manager's Name: SIMMONS WILLIAM llontc Phone: 678 488 - 7847 <br /> P Date Business Opened In Pasco County: 01-18-08 <br /> • Physical l,ocailon 01 Business: PHYSICAL ADDRESS OF BUSINESS <br /> R E QuURID �/ "I.5 I el P/c et <br /> w mailin AtIdrts,: �Lj7' l� oz <br /> . 0 �I <br /> m Federal deral IE:mployer 11) ()r Social Sccurily Number: 582507749 Raciness Phone: 866 377 - 9225 <br /> I. S..:U$.US.iiI,) ItJ (ohas III) 11) 111111 SWIM SWIM' 11,' 11111.8 WV ISSI !NG I41l( <br /> • Sales Tax Registration Number: <br /> • Shoo Or ('onnly 1(04001nr'' License Numht' I :chires: <br /> • Fees: 7as 13.75 Pcnalte :b Other "'SO(; $ 20.00 <br /> ('Small ()tidal ny (iencrn)ta ill Il;rillrllous Maucri,(l) <br /> m Number OF EMPLOYEES t 1 1f "Number O1 Changed. See Fee Schedule Belot: <br /> (employees. seat' ;, =chino. CIc.) <br /> 1 — 5 13.75 16 — 20 70.00 <br /> 1 — 10 33.75 21 —9999 93.75 <br /> 1 A'I°1AC'I I ( •(II'U :S OF: <br /> RI {'l'11RN Tills I Ol(M IN'IA( 1' W1 APPROPRIATE FEE AND ('(PINS OF ABOVE 1)I {S( WIWI) 1)O(IIMI ?NT . BUSINESS 'FAX <br /> RECEIPTS I ?XPIRF. SEPTEMBER 31111 I, OCTOBER THROUGH JANUARY AMOUNTS INCLUDE LA'I'N RENEWAL PENALTY, <br /> DO NOT DETACIj - RETURN ENTIRE FORM INTACT Poo_ • a (R O4I )fO1 <br /> BUSS TAX NOTICE • pAsco COUNTY FLORIDA <br /> 2009 -2010 LICENSE YEAR ACCOUNT 07 EXPIRES 9/30/10 <br /> TOTAL DUE BY: (PENALTY AFTER SEP 30TH)ODE 7349.06 <br /> L SEP 30 OCT 31 NOV 30 DEC 31 JAN 30 JAN AMOUNT <br /> 33.75 35.13 35.81 36.50 37.19 APPLIES THEREAFTER <br /> PAYABLE TO: MIKE OLSON, TAX COLLECTOR/ P.O. BOX 276, DADE CITY FL 33526 -0276 <br /> SIGN HERE -> I CEHTII :YINA ALL INF.ORMATIONPROVID/1) 1H1; AitOvt <br /> APPLICATION FOR THIS BUSINESS TAX HECEIPT IS TRUE AND <br /> CORRECT <br /> I 'IIII.0 1111 III'lllu" Iyll <br /> AUTHORIZED SIGNATURE DATE <br /> SIMMONS OVENS RESTAURANT CLEANING INC <br /> 1458 GREAT SHOALS CIR <br /> LAWRENCEVILLE GA 30045 -7092 <br /> ntc /17 .no c .nn4 c inn inn 2000000000137520000020008000747839 <br />