NOTARIZED STATEMENT FOR CITY OF WILMINGTON 
                          BUSINESS LICENSE 

                  SEC.5-103 ELECTION TO PAY REDUCED LICENSE FEE 

If any licensee, after being licensed for a full calendar year, shall have gross receipts of ten thousand dollars ($10,000.00) or less 
for the calendar year preceding the license year, such licensee may elect to pay a license fee of thirty dollars ($30.00) in lieu of 
the applicable license fee established by this article for each category or classification. 

Any licensee electing to utilize this option must submit a notarized affidavit to the Department of Finance, Business Licenses on 
or before the delinquency date stating the total gross receipts for the preceding year. 

                    * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *              

DATE:               ACCOUNT NO.                                                             LICENSE NO. 

OWNER'S NAME:  

TRADE NAME:  

BUSINESS ADDRESS: 

TELEPHONE NUMBER: (     )  - 

I declare under penalty of making a false statement that to the best of my knowledge the true and correct amount of my gross 
receipts for the year of                      were $                              , and that I am authorized to make said declaration for the purpose 
of determining the amount of the City Business License fee. 

                                                                                            Signature 

Sworn to and subscribed in my presence before me this                  day of               A.D. 20          . 

                    New Castle County 
                    State of Delaware                                          NOTARY PUBLIC 

                    My commission expires: 

\\CITY-WORLDOX\WORDPROCESSING\WDOX\10115301\W0053595.DOC / 11/12/2019                                                                                 Revised:11/12/2019