CITY OF CULLMAN, ALABAMA
ANNUAL BUSINESS LICENSE
NOTE: Both forms with payment must be submitted.

City of Cullman
P.O. Box 278
Cullman, AL  35056-0278
Email: cullrev@cullmancity.org
Telephone: (256) 775-7109
Fax: (256) 775-7132
Web: www.cullmancity.org
License I.D. #:_________________
.

Due: _________________    Paid: _________________

Short: _________________  Over: _________________
 
License renewal is due on January 1 and becomes delinquent February 1.
A 15% penalty is due if not paid by January 31 and a 30% penalty if not paid by March 1.
Business Type:Retail  W'sale  Cont  Svc  Prof  Mfg Rental  Other
Business Name:
Street Address:
 (City)    (State)    (Zip) 
Mailing Address:
 (City)    (State)    (Zip) 
Telephone:  (Business)    (Fax)     (Alternate)
Owner/Officer's Name:
LICENSE COMPUTATION AREA
Lic. Sch. Business Description Gross Receipts Other Receipts License Amount Due
$ $ $
Total License Amount →→→→→→→→→→→→→ $
Prior Year Adjustment →→→→→→→→→→→→→ $
  Penalty→ % % $
  Interest→→→→→→→→→→→→→ $
  Issuing Fee→→→→→→→→→→→ $10.00
  TOTAL AMOUNT DUE→→→→→→→→ $
I declare under penalties of perjury that this application for license has been examined by me and to the best of my knowledge and belief is a true, correct, accurate, and complete statement.


_____________                ____________________________________________________
Date                                  Signature (Required for Acceptance)