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: $15

   Town of Kersey Business License: $15

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

26. Tax Number

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

30. Names of partners or officers of business:

32. "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"

34. Applicant's or Agent's Signature

35. Date
    Date

37. Title

Leave This Blank:


38. Submit Submit and Print

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