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Robert S. Wertz, Jr. Web loudoun.gov/COR Phone [PHONE REDACTED] Mailing Address PO Box 8000 Leesburg, VA 20177-9804 In-person Service Leesburg - 1 Harrison Street SE, 1st Floor Sterling - 46000 Center Oak Plaza Going Out of Business Permit Application Business Information Trade Name Owner/Principal Name FEIN (if none, use SSN) or Account Number [ ] [ ] [ ] [ ] Ownership Type Partnership Sole Proprietor Corporation Limited Liability Company (LLC) Nature of Business Business Email Date Business Terminates Business Phone Business Location Address Sale Information This is the [ ] [ ] First Sale Renewal Application Sale Begins (Date) (Time) Sale Address Describe Merchandise [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] Does sale include all stock on hand? Yes No (attach explanation) Advertising Method(s) Radio TV Newspaper Direct Mail Online Other Attachments include the required fee and [ ] [ ] [ ] Ad copy for radio, TV, newspaper, direct mail, internet or other advertising Inventory of goods covered by permit issued pursuant to this application Explanation, if not all goods in stock are included in sale Certification [ ] I certify that the statements shown on this application and any supporting attachments are true and correct to the best of my knowledge and belief.* [ ] [ ] I understand that only items listed in the inventory attached may be sold under this permit. I will display the permit I receive based on this application prominently within the business location and include the permit number on all advertisements for the going out of business sale. Signature Date Signed Printed Name Business Title/Role *Under Virginia law, it is a misdemeanor to sign a tax return if you do not believe it is true and correct. Virginia Code Section 58.1-11. Office Use Only [ ] Received Fee - $65.00 Index 32021 Sub-object 0449 Permit # - LS Expires OBO, Treasurer Date Approved OBO, Commissioner of the Revenue Date Approved 1 I BTA7-0625 SIGN ---PAGE BREAK--- Going Out of Business Permit Application General Information To protect consumers, Virginia law and Loudoun County ordinance require retail businesses to obtain a "going out of business" sale special license permit from the locality where the sale will be conducted before advertising the sale. Please note: • You must submit permit applications at least 14 days before the sale begins with the $65 application fee. • The permit must be displayed prominently at the location of the Going Out of Business Sale and the permit number must be included in all advertisements for the sale. • Permits expire 60 days after they are issued but may be renewed one-time only for an additional 60 days with a renewal application. Such applications may not contain inventory not included in the original application. Review relevant info at: loudoun.gov/BusinessTax. Use this form to apply for a permit to conduct a Going Out of Business sale at a specific location. You can find online forms at loudoun.gov/COR-Forms. Need help? Staff assistance is available Monday through Friday, during County business hours. To reduce your wait time, we encourage scheduling an appointment. We are open 8:30 AM to 5:00 PM in: Leesburg 1 Harrison St. SE, 1st Floor Sterling 46000 Center Oak Plaza For assistance with a specific topic, email or call: Business Tax Assessment [EMAIL REDACTED] [PHONE REDACTED], option 2 Accommodations: If you require a reasonable accommodation for any type of disability or need language assistance in order to access this form, please contact [EMAIL REDACTED]. Three business days advance notice is requested. Privacy: This Office protects records according to applicable Virginia statutes and U.S. federal laws. Any personal information we collect and maintain is retained in compliance with statute. Instructions Use one form per business location in Loudoun County. 1. Business Information - Supply all requested information about the business that is conducting the "going out of business" sale, including the business name, business tax account number or Taxpayer Identification Number (Federal Employer Identification Number or Social Security Number), description of the nature of the business, the day the business closes, and the name of the business owner, business's ownership type (select one), business email, phone number, and location address. 2. Sale Information - Supply whether this is the first or a renewal application, on what date and at what time the sale will begin, the address at which the sale will be conducted if different from the business location, a description of the merchandise, whether all stock on hand will be included, and what advertising methods will be used. Indicate any attachments that are included with this application. 3. Certification - Complete and sign the certification, indicating the title or role of the legally authorized signer. 4. Submit this form in-person with the required fee at one of the locations listed above or Mail it to: Business Tax Assessment, PO Box 8000, Leesburg, VA 20177-9804 2 I Loudoun County I Office of the Commissioner of the Revenue I BTA7-0525