TOWN OF EMPIRE - Colorado
TOWN OF EMPIRE
30 East Park Avenue – Empire CO 80438-0100
|DO NOT WRITE IN THIS |
|SPACE |
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|License # ________________ |
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|Issued: __________________ |
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|By: _____________________ |
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|Admin Review ____________ |
|_________________________ |
303/569-2978 – 303/569-2282 fax
BUSINESS LICENSE APPLICATION
for 2020
Annual Renewal due prior to January 31, 2020
FEE: $75.00
Establishments which serve alcohol or sell marijuana FEE:$187.50
DATE:______________ NEW OR RENEWAL
(Circle one)
ACTUAL NUMBER OF PERSONS RESIDING ON PREMISES _____________
BUSINESS NAME: _________________________________________________
TYPE OF BUSINESS ________________________________________________
OWNER: ________________________________ HOME PHONE: ___________
BUSINESS ADDRESS: ______________________________________________
MAILING ADDRESS: _______________________________________________
EMAIL ADDRESS OR WEBSITE; _____________________________________
BUSINESS PHONE: _________________________________________________
STATE SALES TAX NUMBER: _______________________________________
PLEASE SEND THIS FORM BACK. LICENSE HOLDER MUST NOTIFY THE TOWN OF ANY CHANGES IN THE INFORMATION LOCATED ABOVE.
I affirm that the information contained in this application is true and accurate.
__________________________ _________________________
Signature of Applicant Date
(Please make checks payable to the Town of Empire, P.O. Box 100 Empire, CO 80438)
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