APPLICATION FOR BUSINESS OR PROFESSIONAL LICENSE

APPLICATIONS ARE MAILED AT END OF FEBRUARY EACH YEAR TO CURRENT LICENSEES - DELINQUENT AFTER MAY 1 - A 10% PENALTY APPLIES AFTER MAY 15

 NO FURTHER NOTICES WILL BE SENT – BUSINESSES CAN BE LEGALLY CLOSED BY THE TOWN FOR FAILURE TO OBTAIN A LICENSE 

APPLICANT______________________________________________INDIVIDUAL    ___________                                           

NAME OF BUSINESS______________________________________PARTNERSHIP       _________                   

 LOCATION ADDRESS__________________________________ CORPORATION   _________

 MAILING ADDRESS_______________________________________ TELEPHONE__________________                                         PO BOX OR STREET ADDRESS

_______________________________________________
                     CITY, STATE AND ZIP CODE

*Home Address of Owner/Manager:______________________________________________________________________________________________
                                          Street name and number                                        City                                                                           State

 *Home Telephone Number of Owner/Manager: _(______)_____________________________________

*Needed in emergency if business is not open.

 NATURE OF BUSINESS________________________________________________________________________

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BASIS FOR LICENSE

Existing Business:

CATEGORY___________ACTUAL GROSS RECEIPTS __________

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New Business:

Business/Professional commencing new business – FIRST TIME LICENSING FEE IS $30.00>

CATEGORY___________ACTUAL GROSS RECEIPTS __________

Business/Professional operating less than twelve (12) full months
between January 1, 20_____ and December 31, 20_____

Provide actual gross receipts for months in operation.

Business commenced__________________________________________

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Retail Merchants to sell beer or wine please check____ and add a $25.00 fee for ABC business license.

I (we) hereby certify that amount(s) reported as gross receipts or gross purchases from my business or profession as reported herein are true and correct. 

____________________________________________     _______________________________________________
Signature of Applicant                                                                               Signature if other than Applicant

 ____________________________________________     _______________________________________________
Title                                                                                                             Company