Tax License Application

2. Fee

   Town of Kersey Sales Tax License $15

   Town of Kersey Sales Tax License $15

4. License to be issued to:

6. Type of Ownership

   1. Association
   2. Corporation
   3. Individual

   1. Partnership
   2. Other

8. Trade name (if any):

10. Business Location

12. City

13. State

14. Zip Code

16. Mailing Address

18. City

19. State

20. Zip Code

22. Phone

24. Tax Number

26. Product(s) or service(s):

28. Names of partners or officers of business:

30. "I declare, under penalty of perjury, that this application has been examined by me and the statements made herein are made in good faith pursuant to the Town of Kersey tax laws and regulations and to the best of my knowledge and belief, are true, correct, and complete."

    "I declare, under penalty of perjury, that this application has been examined by me and the statements made herein are made in good faith pursuant to the Town of Kersey tax laws and regulations and to the best of my knowledge and belief, are true, correct, and complete."

32. Applicant's or Agent's Signature

33. Date
    Date

35. Title

Leave This Blank:


36. Submit

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