New Submission

General Information

License Number*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Business Name*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Due Datefield type date
Reporting Quarter*field type drop-down
Quarter Start Date*field type date
Quarter End Date*field type date
Business Type*field type drop-down

Please select a "Business Type" before proceeding with the Fees Calculations.
A. Gross Receipts*field type currency
$
B. Tax Ratefield type currency
$Gross Receipts x Tax Rate
C. Amount Due*field type currency
$Current + Past Due Bills
D. Subtotalfield type currency
$Tax Rate (B) + Amount Due (C)
C. Total Duefield type currency
$
The total amount owed includes the minimum base tax of $250.00. If your reported gross receipts are lower or amount to zero, you are required to pay the minimum base tax.

Name*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Title*field type single line
Examples: President, CEO, Owner, Operator, Accountant, or Outside Council
Input blocked. Maximum character limit of 4000 characters reached.
Phone Number*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Emailfield type email
Signature*field type signature
Datefield type date
Date will be captured on form submission