Application For Starting A New Business Form - Gloucester County
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1
2Gloucester County
COMMISSIONER OF THE REVENUE’S OFFICE
6489 MAIN STREET, SUITE 137
GLOUCESTER, VA 23061
(804) 693-3451 OR (804) 693-1318
FAX (804) 693-3581
APPLICATION FOR STARTING A NEW BUSINESS
Zoning (Community Development)
Clerk of Circuit Court
Health Department
(804) 693-4040
(804) 693-2502
(804) 693-6130
Type of Ownership:
Individual
Partnership
Corporation
Joint
LLC
Applicant/Owner (Based on Ownership): ____________________________________________________________________
Soc. Sec. Or Fed. ID #: __________________________________________________________________________________
Trade Name: __________________________________________________________________________________________
Must register trade name with Gloucester’s Clerk of Circuit Court. Copy of registration required.
Mailing Address: _______________________________________________________________________________________
_______________________________________________________________________________________
Home Phone: _______________________________ Business Phone:____________________________________________
E-mail Address: ________________________________________________________________________________________
Business Location:
Residence
Business Property
Business Address: ______________________________________________________________________________________
Must obtain approval of your location from Gloucester’s Zoning office. Copy of approved permit from zoning required.
Local Contact Person and phone #:__________________________________________________________________________
Detailed Description of All Proposed Business Activities: ________________________________________________________
_______________________________________________________________________________________________________
(Note: Contractors must complete a Workers’ Compensation Certification to submit with this application.)
Will this business sell food? Yes
No
(Note: A business selling any food or beverages must contact the Health Department before a business license will
be issued. The Health Dept. will provide a statement for you to submit to obtain your business license.)
Date Business will start in Gloucester County: ________________________________________________________
Estimated gross receipts of business this year: _________________________________________________________
The Rate & Fee Schedule with additional requirements is on the reverse side.
Contact this office to inquire about the Prepared Food & Beverages Tax and the Transient Lodging Tax.
OATH: I the undersigned applicant do swear (or affirm) that the foregoing figures and statements are true, full and correct to the
best of my knowledge and belief.
APPLICANT’S SIGNATURE: ___________________________________________________ DATE: __________________
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Parent category: Business