Business Termination Form

CITY OF READING , PENNSYLVANIA

COAT OF ARMS - WHITE CIRCLE

CITIZEN SERVICE CENTER
815 WASHINGTON STREET
READING , PA 19601-3690
877-727-3234
WWW.READINGPA.GOV



 

Termination of Business Statement



 
Date:
 
 
City License Number:
 
 
Account Name:
 



 
I,
 
of the above reference business notify the

Owner/officer's name & title

Tax Administration that we have ceased conducting business in the City of Reading

as of
 
. I further certify that no business has been conducted in or is

Month Day Year

attributable to the City of Reading after the above date.

 

SIGNATURE ____________________________________Date:__________________________

NOTE: The facts set forth herein are made subject to the penalties of 18 PA C.S._Sec. 4904 relative to unsworn falsifications to authorities.

 

Forwarding Address

 
 
 
 
 
Name
 
Contact phone
 
 
 
Address
 
 
 
City, State, Zip Code
 

FAX: (610) 655-6242 TDD: (610) 655-6442