Tax License Application

2. Fee
   Town of Kersey Sales Tax License $25

   Town of Kersey Sales Tax License $25

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*

23. Email Address:*

25. Sales Tax Number*

27. Product(s) or service(s):*

29. Names of partners or officers of business:*

31. "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."

33. Applicant's or Agent's Signature*

34. Date*
    Date

36. Title*

Leave This Blank:


38. Submit

* indicates a required field