Business License Application

2. Instructions
   Once you submit your application, please call 970-353-1681 to pay the licenses fee. Applications without payment are not processed.

   Once you submit your application, please call 970-353-1681 to pay the licenses fee. Applications without payment are not processed.

4. Fee
   Town of Kersey Business License: $25

   Town of Kersey Business License: $25

6. License to be issued to:*

8. Type of Ownership:*

   1. Association
   2. Corporation
   3. Individual

   1. Partnership
   2. Other

10. Trade name (if any):*

12. Business Location*

14. City*

15. State*

16. Zip Code*

18. Mailing Address*

20. City*

21. State*

22. Zip Code*

24. Phone*

25. Email Address*

27. Sales Tax Number*

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

31. Names of partners or officers of business:*

33. "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"

35. Applicant's or Agent's Signature*

36. Date*
    Date

38. Title*

Leave This Blank:


40. Submit Submit and Print

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