Business Closure Form

Business Closure Form

  1. HC
    COMMISSIONER OF THE REVENUE

    COUNTY OF HENRY

    PO BOX 1077

    COLLINSVILLE VA 24078-1077

    PHONE: (276) 634-4690

  2. BUSINESS CLOSURE FORM
  3. Please read the following carefully and call our office should you have any question before submitting the form.

    Use this form only if a business operating in Henry County has stopped operations permanently or moved out of Henry County to a different jurisdiction. A separate form is needed for each closed location. 

    If you have any questions please contact the Commissioner of the Revenue office at 276.634.4690.

  4. BUSINESS INFORMATION
  5. *Note: Business closed after January 1 of any year will be assessed for that year

  6. OWNER INFORMATION
  7. REASON FOR BUSINESS CLOSURE
  8. STATUS OF BUSINESS ASSETS
  9. Access to Asset List

    *If business was sold, the new owner has to report assets based onthe original cost and purchase date. Do you give permission to share your most recent asset list with the new owner? 

  10. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) you are allowing the release of your asset list, and 2) you may still be required to provide a traditional signature at a later date.

    *NOTE: If you checked "Yes" to share your most recent asset list with the new owner but did not check "I agree" and enter your initials then the asset list WILL NOT be shared with the new owner.

  11. *Please note that closing a business may not exclude you from paying Business Tangible Property tax for the current year.

  12. Electronic Signature Agreement - Business Closure Certification*

    I herby certify that I am not conducting any business at the above business location address and declare under penalty and perjury, that I am authorized to complete this application. To the best of my knowledge and belief, the provided information is true and correct.

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  13. FOR OFFICE USE ONLY:
  14. Additional follow up required?
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