2nmcla - Application For New Mexico Contractor'S License (Page 4 of 6) in pdf

2nmcla - Application For New Mexico Contractor'S License Page 4

Contractor's Licensing Service

page 4 of 4

Signatures

Notary applies to all signatures on this page. Attach additional statements if necessary.

To be signed by the qualifying party(ies)

I hereby certify that if for any reason I terminiate my association with the above firm or cease to be its qualifying party, I will

immediately notify CLSI on behalf of the Construction Industries Division in writing.

I solemnly swear or affirm under penalty of perjury that all information furnished is true and correct to the best of my knowledge

and belief. I understand that any false statement by me herein may result in fines and/or an administrative action against any

license or qualifying party certificate held by me.

_____________________________________________

_________________________________________

Qualifying Party

_____________________________________________

Qualifying Party

NOTE! If the qualifying party is also the owner he/she must also sign below

I hereby certify that if the licensee has a change of address or if for any reason the association with the above named

qualifying party(ies) is changed in any way, that the organization named in this application will immediately notify CLSI on

behalf of the Construction Industries Division in writing.

I solemnly swear or affirm under penalty of perjury that all information furnished is true and correct to the best of my knowledge

and belief. I understand that all false statements made herein can result in administrative action, penalties, fines and criminal

action.

The application must be signed by an individual authorized to legally bind the business entity to a contract

_______________________________________ __

____________________________________________

Authorized Signature

Title

Notary

Subscribed and sworn to before me this ___________day of ___________________, 20___________

seal

_______________________________________

Notary Public

My Commission expires_________________________, 20___________

4NMCLA 03/11/02

2nmcla - Application For New Mexico Contractor'S License Page 4