TOWN OF EMPIRE - Colorado



TOWN OF EMPIRE

30 East Park Avenue – Empire CO 80438-0100

|DO NOT WRITE IN THIS |

|SPACE |

| |

|License # ________________ |

| |

|Issued: __________________ |

| |

|By: _____________________ |

| |

|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)

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download